Abstract
BackgroundTo evaluate the prognostic significance of paranasal sinus invasion for patients with NPC and to provide empirical proofs for the T-staging category of paranasal sinus invasion according to the AJCC staging system for nasopharyngeal carcinoma.MethodsThe clinical records and imaging studies of 770 consecutive patients with newly diagnosed, untreated, and nondisseminated NPC were reviewed retrospectively. The overall survival, distant metastasis-free survival, and local relapse-free survival of these patients were analyzed using the Kaplan-Meier method, and the differences were compared using the log-rank test.ResultsThe incidence of paranasal sinus invasion was 23.6%, with the rate of incidence of sphenoid sinus invasion being the highest. By multivariate analysis, paranasal sinus invasion was shown to be an independent prognostic factor for overall survival, distant metastasis-free survival, and local relapse-free survival (p < 0.05 for all). No significant differences in overall survival, distant metastasis-free survival, and local relapse-free survival were observed between patients with sphenoid sinus invasion alone and those with maxillary sinus and ethmoid sinus invasion (p = 0.87, p = 0.80, and p = 0.37, respectively). The overall survival, distant metastasis-free survival, and local relapse-free survival for patients with stage T3 disease with paranasal sinus invasion were similar to the survival rates for patients with stage T3 disease without paranasal sinus invasion (p = 0.22, p = 0.15, and p = 0.93, respectively). However, the rates of overall survival and local relapse-free survival were better for patients with stage T3 disease with paranasal sinus invasion than for patients with stage T4 disease (p < 0.01, and p = 0.03, respectively).ConclusionsParanasal sinus invasion is an independent negative prognostic factor for NPC, regardless of which sinus is involved. Our results confirm that it is scientific and reasonable for the AJCC staging system for nasopharyngeal carcinoma to define paranasal sinus invasion as stage T3 disease.
Highlights
To evaluate the prognostic significance of paranasal sinus invasion for patients with Nasopharyngeal carcinoma (NPC) and to provide empirical proofs for the T-staging category of paranasal sinus invasion according to the American Joint Committee on Cancer (AJCC) staging system for nasopharyngeal carcinoma
The seventh edition of the American Joint Committee on Cancer (AJCC) staging system is widely used throughout the world, and patients with NPC and paranasal sinus invasion are defined as stage T3 according to the staging system [3]
The results of Pan et al revealed that when paranasal sinus invasion were classified as T3 according the 7th edition AJCC T classification, the segregation of local relapse-free survival (LRFS) curves between stage T3 and T4 groups could be well displayed [6]
Summary
To evaluate the prognostic significance of paranasal sinus invasion for patients with NPC and to provide empirical proofs for the T-staging category of paranasal sinus invasion according to the AJCC staging system for nasopharyngeal carcinoma. Tao et al developed a prognostic scoring system (PSS) that could help identify NPC patients with different risk for locoregional relapse, and found that sphenoid sinus, ethmoid sinus and maxillary sinus invasion were classified as different risk groups [4]. While Mao et al considered sphenoidal sinus invasion alone had a better outcome for patients with NPC than did other paranasal sinus invasion [5]. Both studies indicated that tumor invasion into the different paranasal sinuses might have different effects on the prognosis of patients with NPC. In a sense, have provided evidence and reference for the AJCC T- staging
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