Want to take quizzes and track your credits?
Are there differences in survival between de novo and inverted papilloma–associated sinonasal squamous cell carcinoma pathogenesis?
In this systematic review and meta-analysis of 26 studies with 1194 unique patients, those with de novo sinonasal squamous cell carcinoma (dnSCC) had almost a 2-fold increased risk of mortality compared with those with inverted papilloma–associated squamous cell carcinoma (IPSCC).
These findings suggest that compared with dnSCC, IPSCC may represent a less aggressive form of malignancy; if future prospective studies corroborate these results, de-escalation of IPSCC treatment may be considered to limit morbidity.
Overall, the prognosis of sinonasal squamous cell carcinoma (SCC) is poor. This malignancy can arise de novo or from inverted papillomas, but it is unclear whether survival differences between the 2 pathologies exist.
To assess for survival differences between patients with sinonasal de novo SCC (dnSCC) and those with inverted papilloma–associated SCC (IPSCC).
A search of Ovid MEDLINE, Embase, Scopus, and the Cochrane Library from inception to January 23, 2020, with cross-referencing of retrieved studies, was performed. Additional data were requested from authors.
Inclusion and exclusion criteria were designed to capture studies with survival outcomes of adults with sinonasal SCC who underwent regular treatment. Clinical trials, cohort studies, case-control studies, and case series with more than 10 adults aged 18 years or older with sinonasal SCC were included. Exclusion criteria were studies on non-SCC sinonasal neoplasms, studies without histopathologic diagnoses, non-English language articles, nonhuman animal studies, and abstract-only articles. Two blinded investigators (J.J.L., A.M.P., T.W.E., or N.S.W.) screened each abstract and full text, and a third investigator (J.J.L. or P.P.) adjudicated discrepancies. Of 729 unique citations, 26 studies of 1194 total patients were included.
Data Extraction and Synthesis
Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed. The Methodological Index for Nonrandomized Studies (MINORS) criteria were used to assess study quality. Two blinded investigators (J.J.L., A.M.P., T.W.E., or N.S.W.) independently extracted data from each study. Data were pooled using a random-effects model.
Main Outcomes and Measures
The primary outcome was overall survival, and secondary outcomes were disease-free and disease-specific survival. Before data collection, it was hypothesized that the dnSCC cohort would have worse survival outcomes than the IPSCC cohort.
One study of patients with dnSCC, 12 studies of patients with IPSCC, and 5 studies with both cohorts were included in the meta-analysis of overall survival. The pooled 5-year overall survival rate for 255 patients with dnSCC was 56% (95% CI, 41%-71%; I2 = 83.8%) and for 475 patients with IPSCC was 65% (95% CI, 56%-73%; I2 = 75.7%). Five comparative studies of both cohorts totaling 240 patients with dnSCC and 155 patients with IPSCC were included in another meta-analysis. The pooled overall survival hazard ratio was 1.87 (95% CI, 1.24-2.84; I2 = 0%).
Conclusions and Relevance
This systematic review and meta-analysis found that patients with dnSCC had almost a 2-fold increased risk of mortality compared with those with IPSCC. Large, multicenter studies are necessary to validate these findings before considering treatment alterations such as de-escalation based on histopathology.
Sign in to take quiz and track your certificates
JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC
Accepted for Publication: November 22, 2020.
Published Online: January 28, 2021. doi:10.1001/jamaoto.2020.5261
Corresponding Author: Jake J. Lee, MD, MSCI, Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, 660 S Euclid Ave, Campus Box 8115, St Louis, MO 63110 (email@example.com).
Author Contributions: Dr Lee had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Lee, Pipkorn.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Lee, Peterson.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Lee, Kallogjeri.
Administrative, technical, or material support: Lee, Peterson, Embry.
Supervision: Lee, Klatt-Cromwell, Pipkorn.
Conflict of Interest Disclosures: Dr Kallogjeri reported serving as statistics editor for JAMA Otolaryngology–Head and Neck Surgery outside the submitted work. No other disclosures were reported.
Funding/Support: This research was supported by grant 5T32DC000022 from the National Institute of Deafness and Other Communication Disorders within the National Institutes of Health (Drs Lee and Wamkpah) and by grant UL1TR002345 from the National Center for Advancing Translational Sciences of the National Institutes of Health (Mr Peterson and Mr Embry).
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Kallogjeri is Statistics Editor of JAMA Otolaryngology–Head & Neck Surgery but was not involved in any of the decisions regarding review of the manuscript or its acceptance.
Additional Contributions: We thank Graham A. Colditz, MD, MPH, and Carrie Stoll, MPH, MSW, of the Washington University Division of Public Health Sciences, for their instruction on the proper conduct of systematic reviews and meta-analyses and their feedback. We also thank Carol H. Yan, MD, of the University of California, San Diego, for sharing deidentified individual patient data from her previous publication in order to support this meta-analysis. No one was financially compensated for their contributions.
You currently have no searches saved.