Development of a Sinonasal Squamous Cell Carcinoma Database to Investigate the Impact of Human Papillomavirus on Outcomes

Background: Sinonasal malignancies are rare comprising 5% of all head and neck malignancies but are aggressive cancers with a poor prognosis. Sinonasal squamous cell carcinoma (SNSCC), in particular, has a 5-year overall survival of 34 to 40%. Increasing evidence has shown that human papillomavirus (HPV) is associated with a subset of SNSCC. However, existing studies have been limited by small sample sizes or variability in HPV detection methods. The impact of HPV to oncologic outcomes and its association with adverse pathologic features remain to be fully elucidated.

Objectives: This article aims (1) to develop a large database of patients with SNSCC treated with primary surgical resection with or without adjuvant radiation ± chemotherapy and (2) to investigate associations of human papillomavirus with outcomes and adverse pathologic features.

Methods: Patients treated for SNSCC with primary surgery between January 2006 and August 2023 at a single academic institution were identified. Clinical and pathologic data for these patients were collected retrospectively from patient charts. Patient characteristics and pathologic features of the resected specimen were compared by evaluating p16 expression as a marker of HPV status on available formalin-fixed paraffin embedded tumor blocks. Overall survival using Kaplan-Meier estimation was compared between HPV-related and -unrelated SNSCC patients.

Results: One hundred and one patients were identified who underwent primary surgical resection for SNSCC with sufficient clinical and outcomes data on chart review. Forty-two patients were evaluated for p16 expression of which six patients were negative and 36 were positive. There were no significant differences in clinical characteristics such as age, sex, smoking or drinking history, history of nasal polpys or inverted papilloma, or adverse pathologic features such as advanced T staging, perineural invasion, lymphovascular invasion, or positive margins between HPV-related and -unrelated SNSCC patients. There was a statistically significant difference in subsite distribution with HPV-unrelated SNSCC patients more likely to arise from the nasal cavity (p = 0.031). There was no difference in overall survival between the two cohorts (p = 0.70).

Conclusion: This study represents the preliminary analyses of a cohort of 101 SNSCC patients who underwent primary surgical excision followed by pathology driven adjuvant therapy. Currently, our cohort of patients who have been tested for p16 expression remains small and has not demonstrated a difference in mortality or significant clinicopathologic features. Efforts are underway to evaluate more patients’ HPV status and other immunohistochemical features using available formalin-fixed paraffin embedded tumor blocks to continue to develop this database for further analyses.