Prognostic Factors in Intestinal-type Sinonasal Adenocarcinoma: A 10-year Single-center Retrospective Cohort Study

Abstract

Objectives

This study assesses the prognostic impact of tumor invasion patterns and anatomical topography in patients with primary intestinal-type sinonasal adenocarcinoma (ITAC). Specifically, we evaluate the relationship between key invasion sites and overall survival to improve risk stratification and surgical decision-making.

Design and Setting

A retrospective, single-center cohort study was conducted at Unidade Local de Saúde São João, Porto, Portugal.

Participants

A total of 30 patients with a primary diagnosis of sinonasal ITAC between 2014 and 2024 who underwent surgical resection were included.

Main Outcome Measures

Survival outcomes were evaluated using Kaplan-Meier survival analysis, with a specific focus on tumor laterality, dural and subpial invasion, sphenoid and orbital invasion, and overall tumor burden. Additionally, the effects of clinical and treatment-related parameters were evaluated.

Results

A significantly poorer survival was found in tumors with subpial invasion at diagnosis (p < 0.001), whereas dural invasion showed a trend toward significance (p = 0.053). The influence of orbital and sphenoid invasion on survival was negligible. Left-sided tumors showed a worse prognosis compared to right-sided lesions (p = 0.003). Patients selected for purely endoscopic surgical approaches and gross total resection (GTR) were linked with better outcomes.

Conclusion

Our results emphasize the need for a comprehensive preoperative evaluation of important anatomical invasion locations and the prognostic importance of subpial invasion and tumor laterality in ITAC. Preoperatively identifying high-risk features may refine surgical planning and treatment choices, optimizing survival outcomes in this aggressive malignancy.

Keywords

intestinal-type adenocarcinoma - tumor invasion patterns - prognostic factors - survival - sinonasal tumors

Contributors' Statement

S.A.: conceived the study, designed the methodology, collected and curated data, performed statistical analyses, and drafted the manuscript; C.S.: performed the topographic analysis of the tumors, provided critical feedback on the manuscript, and extensively revised it; P.A.S.: conceptualized the study, supervised the research process, provided methodological guidance, and critically reviewed and revised the manuscript; M.L.: critically revised the manuscript for important intellectual content.

Publication History

Received: 13 May 2025

Accepted: 04 December 2025

Accepted Manuscript online:
08 December 2025

Article published online:
31 December 2025

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