Association of surgical approach and margin status with oncologic outcomes following gross total resection for sinonasal melanoma Journal Article

Authors: Sayed, Z.; Migliacci, J. C.; Cracchiolo, J. R.; Barker, C. A.; Lee, N. Y.; McBride, S. M.; Tabar, V. S.; Ganly, I.; Patel, S. G.; Morris, L. T.; Roman, B. R.; Shoushtari, A. N.; Cohen, M. A.
Article Title: Association of surgical approach and margin status with oncologic outcomes following gross total resection for sinonasal melanoma
Abstract: IMPORTANCE Sinonasal mucosal melanoma (SMM) is a rare malignant neoplasm characterized by a poor prognosis despite aggressive intervention including wide surgical resection. Margin status has previously been cited as an important prognostic factor for local control and overall survival (OS) in patients who undergo either an open or endoscopic surgical approach. No comparisons have been made, however, in patients who have undergone gross total resection with or without positive margins. OBJECTIVE To assess the association of margin status and surgical approach with oncologic outcomes in patients with SMM undergoing gross total resection.DESIGN, SETTING, AND PARTICIPANTS In this cohort study, patients with SMM without evidence of regional or distant disease treated with curative intent in part or full at MemorialSloan Kettering Cancer Center from 1998 through 2016 were retrospectively assessed. Demographic data, prognostic information, and surgical pathology were reviewed. Operative reports and imaging were used to confirm gross total resection of local disease. EXPOSURES Surgical techniques including open maxillectomy, craniofacial resection, and endoscopic resection. MAIN OUTCOMES AND MEASURES Three-year local recurrence-free survival (LRFS), disease-free survival (DFS), and OS were calculated using the Kaplan-Meier method. Univariate and multivariable analyses of outcomes were carried out using the Cox proportional hazard regression method. RESULTS Seventy-two patients (39 [54%] female; mean [SD] age, 67 [12] years) met the eligibility criteria. Thirty-eight patients (53%) underwent open partial or total maxillectomy with or without ethmoidectomy or sphenoidectomy via a transfacial approach. Fourteen patients (19%) had a more extensive craniofacial approach, and 20 patients (28%) underwent endoscopic resection. The 3-year OS for all patients was 52%. The absolute 3-year difference between patients with open/craniofacial resection vs endoscopic resection for LRFS, DFS, and OS was 11% (95%CI, -21% to 43%), 16%(95%CI, -7%to 39%), and 12% (95%CI, -18%to 41%), respectively. The absolute 3-year difference between patients with a negative margin and patients with a positive margin for LRFS, DFS, and OS was 18%(95%CI, -9%to 45%), 5%(95%CI, -17%to 27%), and 15%(95%CI, -9%to 39%), respectively. Multivariable analysis revealed that none of the adjusted variables (margin status, tumor stage, or surgical approach) were significantly associated with OS. CONCLUSIONS AND RELEVANCE Outcomes for patients with SMM remain poor regardless of operative approach or postoperative margin status. © 2017 American Medical Association.
Keywords: adult; cancer survival; aged; middle aged; cancer surgery; primary tumor; survival rate; major clinical study; overall survival; cancer recurrence; systemic therapy; conference paper; cancer radiotherapy; disease free survival; cancer staging; cancer immunotherapy; cohort analysis; surgical approach; retrospective study; survival time; endoscopic surgery; adjuvant radiotherapy; paranasal sinus cancer; craniofacial surgery; maxilla resection; surgical margin; clinical outcome; mucosal melanoma; nose cavity cancer; local recurrence free survival; ethmoidectomy; human; male; female
Journal Title: JAMA Otolaryngology - Head and Neck Surgery
Volume: 143
Issue: 12
ISSN: 2168-6181
Publisher: American Medical Association  
Date Published: 2017-12-01
Start Page: 1220
End Page: 1227
Language: English
DOI: 10.1001/jamaoto.2017.2011
PROVIDER: scopus
PUBMED: 29049462
PMCID: PMC5808194
Notes: Conference Paper -- Export Date: 1 February 2018 -- Source: Scopus
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MSK Authors
  1. Snehal G Patel
    286 Patel
  2. Viviane S Tabar
    117 Tabar
  3. Nancy Y. Lee
    547 Lee
  4. Christopher Barker
    112 Barker
  5. Luc Morris
    123 Morris
  6. Ian Ganly
    229 Ganly
  7. Benjamin Raphael Roman
    44 Roman
  8. Sean Matthew McBride
    109 McBride
  9. Marc A Cohen
    17 Cohen
  10. Zafar Sayed
    1 Sayed