Adenoid Cystic Carcinoma of the Sinonasal Tract: A Review of the National Cancer Database

Objectives Adenoid cystic carcinoma of the sinonasal tract is a rare malignancy with a propensity for distant metastasis. This study describes the incidence and determinants of survival of patients with sinonasal adenoid cystic carcinoma between the years of 2004 and 2012 using the National Cancer Database (NCDB).

Design Retrospective, population-based cohort study.

Setting Tertiary academic medical center.

Participants Patients who were diagnosed with sinonasal adenoid cystic carcinoma between 2004 and 2012 within the NCDB.

Main Outcome Measures Overall survival (OS).

Results A total of 793 patients were identified. The cohort was composed of 46.9% males. Mean age at diagnosis was 59.6 years. The maxillary sinus was the most common primary site, accounting for 49.7% of cases. 3.6% of patients presented with nodal disease, while 3.7% had distant metastases. 49.1% of cases presented with stage IV disease. 77.4% of patients underwent surgery, 68.2% received radiation therapy, and 16.4% had chemotherapy. Median OS was 78.5 months, while OS at 1, 2, and 5 years was 91, 83, and 61%, respectively. On multivariate analysis, advanced age (p = 0.001), frontal sinus primary site (p < 0.001), positive margins (p < 0.001), Charlson comorbidity index > 0 (p = 0.01), residing in urban setting (p = 0.04), poorly differentiated or undifferentiated tumor grade (p = 0.003), and advanced tumor stage (p = 0.01) were associated with worse OS, whereas surgery (p < 0.001), but not radiation therapy (p = 0.52) or chemotherapy (p = 0.57), predicted improved OS.

Conclusion Predictors of survival in sinonasal adenoid cystic carcinoma include age, comorbidity status, grade, and stage. Surgery is associated with improved survival and remains the mainstay of therapy, whereas the roles of radiation therapy and chemotherapy require future investigations.