Treatment Failure and Overall Survival in Patients with Sinonasal Squamous Cell Carcinoma (SNSCC): A Systematic Review and Meta—Analysis

Objective: Prognosis in SNSCC remains poor mainly for local failure. Due to the rarity of this disease, and heterogeneity as to site and stage, most of the existing studies are based on the experience of individual centers; as such, data from meta-analysis may be of special value. In this meta-analysis, we evaluated patterns of treatment failure—local recurrence (LR), nodal recurrence (NR), and distant metastasis (DM)—and their relationship with overall survival (OS). Data source: A comprehensive search was performed in PubMed/MEDLINE, Web of Science, and Scopus for studies definitely involving treated patients with SNSCC. Review Methods: This study was conducted in accordance with the PRISMA 2000 Statement for Reporting Systematic Reviews Proportional meta-analysis to obtain pooled effect estimates, expressed as OS, local control (LC), distant metastasis-free survival (DMFS), disease-specific survival (DSS), LR rate, nodal recurrence (NR) rate and distant metastases (DM) rate. Rates of LR, NR and DM were analyzed and correlated with 5-year OS. Results: A total of 749 patients in 13 articles were identified. Multimodal treatment was administered in 588 cases (78%), including induction chemotherapy in 300 cases (40%), while 356 patients (47,5%) were treated with surgery followed by adjuvant radiotherapy (RT) or chemoradiotherapy (CHRT). The remaining 393 patients (52,5%) were treated without surgery. The pooled 2-, 3-, 5- and 10-year OS rates were 74%, 51.7%, 50.2% and 46.3%, respectively. The pooled 5-year local control (5-LC) rate was 57%, the pooled LR rate was 27.2% and the pooled NR rate was 11.6%. There was no statistically significant correlation between LR, NR, or DM and 5-year OS. Conclusions: SNSCC remains an aggressive disease with approximately 50% 5-year OS and LR as the main reason of treatment failure, with a rate of 27%. This confirms the necessity of better local control strategies.