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Otorinolaringologia 2010 December;60(4):233-8


language: English

Surgical staging is an important prognostic factor in nasosinusal carcinomas

Fontan Köhler H., Lopes Carvalho A., Hideki Suzuki S., Kowalski L. P.

1 Department of Head and Neck Surgery, Otolaryngology, Hospital A. C. Camargo, São Paulo, Brazil 2 Department of Head and Neck Surgery, Hospital Pio XII, Barretos, Brazil 3 Department of Neurosurgery, Hospital A. C. Camargo, São Paulo, Brazil


Aim. The aim of this study was to report a retrospective case series from a single institution to define prognostic factors for maxillary squamous cell carcinomas and to propose a new surgical staging system. Outcome measurements include prognostic factors for local and distant relapse of maxillary sinus squamous cell carcinomas.
Methods. Ninety-six patients treated between January, 1985 and December, 2005 were included in the study. Treated curative intent was analyzed. Univariate and multivariate survival analysis were performed. The patients were staged after the surgery according to surgical extent and margins’ status.
Results. Twenty-four patients were submitted to surgery alone, 43 to surgery and postoperative radiotherapy and 29 to radiotherapy alone. In surgically treated patients, T3/T4a stage, extension to the ethmoyd sinus, lymphatic invasion, neural invasion, involved surgical margins and bone invasion were significant prognostic predictors in univariate analysis. In multivariate analysis, only involved surgical margins remained significant for survival. The risk of local relapse was affected by involved surgical margins, bone and neural invasion. In a multivariate analysis, only involved surgical margins remained significant. No significant factors were found in the radiotherapy group regarding the rate of local relapse or overall survival. Patients submitted to surgical treatment had a better survival than those treated with radiotherapy (P=0.0032). Patients were grouped in three groups according to postsurgical staging and this variable was shown statistically significant for relapse and survival.
Conclusion. Oncological surgical treatment should be considered the first treatment option in patients with nasosinusal carcinoma. The long-term results of non-surgical treatment were disappointing. Postoperative surgical staging may be useful in defining prognosis.

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