2026 Proffered Presentations
S153: COMPARATIVE ANALYSIS OF REGIONAL METASTASIS ACROSS SINONASAL MALIGNANCIES
Farhoud Faraji1; Omer Baker1; Jennifer E Douglas, MD2; Michael A Kohanski, MD, PhD2; Nithin D Adappa, MD2; James N Palmer, MD2; Thomas L Beaumont, MD, PhD1; Carol H Yan, MD1; Edward C Kuan, MD, MBA3; Adam S DeConde, MD1; Nyall R London, MD, PhD4; 1UC San Diego Health; 2University of Pennsylvania; 3UC Irvine Health; 4Johns Hopkins Medicine
Background: Malignant tumors arising from tissues forming the nasal cavity and paranasal sinuses are collectively termed sinonasal malignancies. These cancers are histopathologically diverse and display variable survival outcomes. Accurate characterization of regional nodal disease with regard to histology is essential for prognosis and clinical management. However, the rare nature of sinonasal malignancies presents a significant challenge to elucidating patterns of regional metastasis.
Methods: We interrogated the National Cancer Database 2004-2022, a hospital-based registry capturing >70% of incident malignancies in the United States. The International Classification of Diseases for Oncology grouping system was implemented to identify the 19 most prevalent histologic types arising from the sinonasal tract. Regional metastasis rates were quantified and clinicopathological features were analyzed to develop a comparative landscape of sinonasal malignancies presenting with regional disease.
Results: Papillary adenocarcinoma, papillary carcinoma, adenocarcinoma, and adenoid cystic carcinoma exhibited the lowest regional metastasis rates (<10%), while squamous cell carcinoma, mucosal melanoma (MM), sinonasal undifferentiated carcinoma (SNUC), and sinonasal neuroendocrine carcinoma (SNEC) displayed relatively high rates (>15%). Rhabdomyosarcoma, NUT carcinoma, lymphoepithelial carcinoma, and olfactory neuroblastoma (ONB) showed notably high metastatic propensities (>25%; Figure 1).
We demonstrate that anatomic subsite may influence regional metastasis rates in certain sinonasal malignancies. For example, while squamous cell carcinoma (SCC), SNUC, SNEC, and adenoid cystic carcinoma (ACC) arising from the nasal cavity, and maxillary and ethmoid sinuses carried relatively low prevalences of regional metastasis, those arising from the sphenoid sinus or from overlapping subsites displayed significantly higher node positivity rates (Figure 2).
Regional metastasis rates generally increased with advancing T category across most histologies. Aggressive histologies such as SNUC and SNEC demonstrate relatively high rates of regional metastasis even for T1 tumors (>7.5%). Notably, limited data are available regarding T categories for rare sinonasal malignancies with high regional metastasis rates like rhabdomyosarcoma, sarcoma, and NUT carcinoma (Figure 3).
Across histologies, three-year overall survival (OS) rates varied widely. Favorable outcomes were observed for papillary adenocarcinoma, papillary carcinoma, and lymphoepithelial carcinoma; each exceeding 70% three-year OS, while aggressive subtypes such as SNUC, SNEC, and MM demonstrated substantially worse survival, often below 50%. Nodal involvement was consistently associated with reduced OS compared with node-negative cases, with largely significant decrements observed for malignancies including adenocarcinoma, SCC, MM, and ONB (Figure 4).
Conclusions: Sinonasal malignancies demonstrate striking heterogeneity in survival and nodal metastatic behavior across histologies and anatomic subsites. Subsite patterns highlight the sphenoid sinus as a nidus for increased nodal propensity, particularly for SCC, SNUC, SNEC, and ACC. While nodal rates generally rise with advancing T category, limited data are available for rare histologies (NUT carcinoma, rhabdomyosarcoma). Nodal involvement generally portends worse survival, with large decrements in overall survival observed in aggressive histologies including SNUC, ONB, adenocarcinoma, SCC, and MM. These findings underscore the potential of histology- and subsite-specific risk stratification to guide regional management strategies.
Figure 1. Regional metastasis rates across histologies
Figure 2. Anatomic subsite and node positivity rates
Figure 3: Relationships between tumor category and node positivity rates
Figure 4: Relationships between nodal status and overall survival
