The MUSES∗: a prognostic study on 1360 patients with sinonasal cancer undergoing endoscopic surgery-based treatment: ∗MUlti-institutional collaborative Study on Endoscopically treated Sinonasal cancers

Marco Ferrari; Davide Mattavelli; Michele Tomasoni; Elena Raffetti; Paolo Bossi; Alberto Schreiber; Ester Orlandi; Stefano Taboni; Vittorio Rampinelli; Tommaso Gualtieri; Mario Turri-Zanoni; Paolo Battaglia; Alberto D Arosio; Maurizio Bignami; Tiziana Tartaro; Marinella Molteni; Giacomo Bertazzoni; Domitille Fiaux-Camous; Clement Jourdaine; Benjamin Verillaud; Donovan Eu; Deepa Nair; Aliasgar Moiyadi; Prakash Shetty; Sarbani Ghosh-Laskar; Ashwini Budrukkar; Stefano M Magrini; Sophie Guillerm; Sandrine Faivre; Cesare Piazza; Ralph W Gilbert; Jonathan C Irish; John R de Almeida; Prathamesh Pai; Philippe Herman; Paolo Castelnuovo; Piero Nicolai

doi:10.1016/j.ejca.2022.05.010

The MUSES∗: a prognostic study on 1360 patients with sinonasal cancer undergoing endoscopic surgery-based treatment: ∗MUlti-institutional collaborative Study on Endoscopically treated Sinonasal cancers

Eur J Cancer. 2022 Aug:171:161-182. doi: 10.1016/j.ejca.2022.05.010. Epub 2022 Jun 17.

Authors

Marco Ferrari¹, Davide Mattavelli², Michele Tomasoni², Elena Raffetti³, Paolo Bossi⁴, Alberto Schreiber², Ester Orlandi⁵, Stefano Taboni⁶, Vittorio Rampinelli⁷, Tommaso Gualtieri², Mario Turri-Zanoni⁸, Paolo Battaglia⁸, Alberto D Arosio⁹, Maurizio Bignami¹⁰, Tiziana Tartaro¹¹, Marinella Molteni¹², Giacomo Bertazzoni¹³, Domitille Fiaux-Camous¹⁴, Clement Jourdaine¹⁴, Benjamin Verillaud¹⁴, Donovan Eu¹⁵, Deepa Nair¹⁶, Aliasgar Moiyadi¹⁷, Prakash Shetty¹⁷, Sarbani Ghosh-Laskar¹⁸, Ashwini Budrukkar¹⁸, Stefano M Magrini¹⁹, Sophie Guillerm²⁰, Sandrine Faivre²¹, Cesare Piazza², Ralph W Gilbert²², Jonathan C Irish¹⁵, John R de Almeida²², Prathamesh Pai¹⁶, Philippe Herman¹⁴, Paolo Castelnuovo⁸, Piero Nicolai²³

Affiliations

¹ Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy. Electronic address: marco.ferrari@unipd.it.
² Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy.
³ Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
⁴ Unit of Medical Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy.
⁵ Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
⁶ Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy; Guided Therapeutics (GTx) Program International Scholarship, University Health Network (UHN), Toronto, ON, Canada; Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
⁷ Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy; Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy.
⁸ Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy; Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
⁹ Division of Otorhinolaryngology, Department of Surgical Specialties, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy.
¹⁰ Division of Otorhinolaryngology, "ASST Lariana", University of Insubria, Como, Italy.
¹¹ Department of Medical Oncology, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy.
¹² Department of Radiotherapy, "ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi", Varese, Italy.
¹³ Department of Otorhinolaryngology, "ASST di Cremona", Cremona, Italy.
¹⁴ Hopital Lariboisiere, APHP Nord - Université De Paris, INSERM U 1141, Paris, France.
¹⁵ Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
¹⁶ Department of Head & Neck Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India.
¹⁷ Department of Neurosurgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India.
¹⁸ Department of Radiation Oncology, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India.
¹⁹ Unit of Radiation Oncology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, "ASST Spedali Civili di Brescia", University of Brescia, Brescia, Italy.
²⁰ Department of Radiotherapy Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France.
²¹ Department of Medical Oncology Assistance Publique - Hôpitaux de Paris, Hôpital Saint Louis, Université de Paris, Paris, France.
²² Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada.
²³ Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, "Azienda Ospedale Università di Padova", University of Padua, Padua, Italy.

PMID: 35724468
DOI: 10.1016/j.ejca.2022.05.010

Abstract

Background: Over the last 2 decades, transnasal endoscopic surgery (TES) has become the most frequently employed surgical technique to treat sinonasal malignancies. The rarity and heterogeneity of sinonasal cancers have hampered large non-population-based analyses.

Methodology: All patients receiving TES-including treatment between 1995 and 2021 in 5 referral hospitals were included. A prognostic study was performed, and multivariable models were transformed into nomograms. Training and validation sets were based on results from 3 European and 2 non-European centres, respectively.

Results: The training and validation set included 940 and 420 patients, respectively. The mean age at surgery, primary-versus-recurrent presentation, histology distribution, type of surgery, T category and type of adjuvant treatment were differently distributed in the training and validation set. In the training set, 5-year overall survival and recurrence-free survival with a 95%-confidence interval were 72.7% (69.5-76.0%) and 66.4% (63.1-69.8%), respectively, significantly varying with histology. At multivariable analyses, age, gender, previous treatment, the extent of resection on the cranial, lateral and posterolateral axes, grade/subtype, T category, nodal status, margin status and adjuvant treatment were all associated with different prognostic outcomes, displaying a heterogeneous significance and effect size according to histology. The internal and external validation of nomograms was satisfactory (optimism-corrected C-index >0.7 and cumulative area under curve >0.7) for all histologies but mucosal melanoma.

Conclusions: Outcomes of TES-based treatment of sinonasal cancers vary substantially with histology. This large, non-population-based study provides benchmark data on the prognosis of sinonasal cancers that are deemed suitable for treatment including TES.

Keywords: Cancer; Chemotherapy; Endoscopic; Nomogram; Prognosis; Radiotherapy; Sinonasal; Surgery; Survival; Transnasal.

MeSH terms

Humans
Melanoma* / surgery
Nomograms
Paranasal Sinus Neoplasms*
Prognosis
Retrospective Studies