Juvenile nasopharyngeal angiofibroma: Clinical factors associated with recurrence, and proposal of a staging system

Abstract

Juvenile nasopharyngeal angiofibroma (JNA) is a vascular tumor of the nasopharynx. Our aim is to analyze prognostic factors, report results obtained with radiation therapy and propose a staging system. Retrospective study of patients with JNA. Clinical, radiological and therapeutic data were assessed for recurrence- and disease free survival-associated prognostic factors. Bivariate and multivariate analyses were performed. Fifty-four males were analyzed. Invasion to anterior infratemporal fossae (ITF) +/or to pterygomaxillary fossae, to posterior infratemporal fossae, or intracranial extension were associated with recurrences in 2 of 15, in 8 of 18, and in 8 of 12 cases, respectively. Tumors < or > or =6 cm were associated with zero and with 18 recurrences, respectively (P = 0.006). A staging system is constructed considering extension patterns and size. Multivariate analyses conferred significance (P = 0.002) to a model including this staging system and surgical margins. Our system stratifies recurrence risk and disease-free survival efficiently. Since radiotherapy at young age has potential to induce malignancies, it should be used with caution. It could be considered as primary treatment in stage IV cases with major invasion to cavernous sinus or orbital apex. Therapy design may be improved.