Sinonasal Squamous Cell Carcinoma Outcomes: Does Treatment at a High-Volume Center Confer Survival Benefit?

Background: Sinonasal squamous cell carcinoma (SCC) is a rare tumor. Treatment involves multiple modalities, as well as a multidisciplinary team of specialists. Due to the complexity and infrequency of sinonasal SCC, clinical volume, and experience of the treating center may contribute to patient outcomes.

Methods: The National Cancer Database (NCDB) dataset from 2004 to 2014 was analyzed. Patients with sinonasal SCC were identified. Patient demographics, tumor characteristics including primary site, tumor classification (T-stage), resection margins, treatment regimen (surgery, radiation, chemotherapy, and multimodality), and facility case-specific volume averaged per year and grouped in tertiles as low (0–33%), medium (33–67%), and high (67–100%) were compared. Overall survival was compared using Cox’s proportional hazards regression analysis.

Results: A total of 3,835 patients who were treated for sinonasal SCC between 2004 and 2014 were identified. Therapeutic options for patients included surgery alone (18.6%), radiotherapy (RT) alone (29.1%), definitive chemoradiation (15.4%), surgery with adjuvant RT (22.8%), and combinations (14.1%) of the aforementioned treatments. On multivariate analysis, patients who underwent surgery with adjuvant RT had better overall survival (HR = 0.74, p ≤0.001, CI: 0.63–0.86). As for treatment volume per facility, 7.4% of patients were treated at a low-volume center, 17.5% at a medium-volume center, and 75.1% at a high-volume center. For all patients who underwent treatment, univariable analysis showed that treatment at a high-volume facility conferred a significantly better overall survival (HR = 0.77, p = 0.002). Multivariable Cox-PH regression analysis adjusting for age, sex, tumor classification, and treatment regimen demonstrated that patients who underwent treatment at a high-volume facility (HR = 0.81, p < 0.001) had statistically significantly improved survival.

Conclusion: This study shows a better overall survival for sinonasal SCC treated at high volume centers. Further study may be needed to understand the effect of case volume on the paradigms of sinonasal SCC management.