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 Thirty 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-seated 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.
