Risk of lymph node metastasis and recommendations for elective nodal treatment in squamous cell carcinoma of the nasal cavity and maxillary sinus: a SEER analysis

Figures & data

Table 1. Prior literature on nodal presentation at diagnosis or subsequent nodal recurrence in patients with nasal cavity SCC or maxillary sinus SCC, in those who initially presented with N0 disease.

Author/institution	Site	(n, squamous cell, evaluable)	Initial nodal involvement	Subsequent nodal recurrence (no elective treatment or no information), initial N0	Subsequent nodal recurrence (initial elective treatment), initial N0
Scurry et al., meta-analysis	Nasal cavity	830	55/830 (6.6%)	146/766 (19.2%)	2/54 (3.7%)
Allen et al., MD Anderson	Nasal cavity	45	N/R	4/31 (12.9%)	0/13 (0%)
Total evaluable (nasal cavity SCC)		875	55/830 (6.6%)	150/797 (18.8%)	2/67 (2.9%)
Total evaluable for nasal cavity SCC (including current study)		1608	123/1563 (7.9%)
Rinaldo, meta-analysis	Maxillary sinus	681	73/681 (10.7%)	75/608 (12.3%)
Le et al., Stanford	Maxillary sinus	58	9/58 (15.5%)	6/36 (16.7%)	0/13 (0%)
Jiang et al., MD Anderson	Maxillary sinus	36	5/36 (13.8%)	6/18 (33.3%)	0/16 (0%)
Jeremic, VU	Maxillary sinus	44	N/A	N/A	2/44 (4.5%)
Total evaluable (maxillary sinus SCC)		819	87/775 (11.2%)	87/662 (13.1%)	2/73 (2.7%)
Total evaluable for maxillary sinus SCC (including current study)		1369	201/1325 (15.2%)

Results from the (maxillary sinus) Rinaldo meta-analysis modified to exclude the Stanford and MD Anderson studies.

N/A: not applicable; N/R: not reported; SCC: squamous cell carcinoma.

Table 2. T-stage, size, grade, and nasopharyngeal involvement in risk of nodal involvement.

		Univariate analysis (N)	Univariate odds ratio (95% CI)	Multivariable analysis (N)	Multivariable odds ratio (95% CI)
Nasal cavity	T-stage	p < 0.001 (733)	1.7 (1.42, 1.99)	p = 0.003 (425)	1.6 (1.17, 2.22)
	Size (log)	p = 0.012 (425)	2.6 (1.71, 4.09)	p = 0.04 (425)	1.8 (1.03, 3.21)
	Nasopharyngeal involvement	p = 0.019 (733)	3.06 (1.27, 7.40)	p = 0.475 (425)	N/A
	Grade	p = 0.093 (589)	1.36 (0.95, 1.95)	p = 0.768 (425)	N/A
Maxillary sinus	T-stage	p = 0.007 (550)	1.3 (1.06, 1.56)	N/A	N/A
	Size	p = 0.133 (353)	1.01 (0.997, 1.02)	N/A	N/A

Bold values represent p-value ≤0.05.

Figure 1. Nodal metastases at presentation: (a) depiction of each of levels 1–5, RP, intraparotid, and facial nodes. In (b) all nasal cavity SCC and (c) all maxillary sinus SCC.

RP: retropharyngeal; SCC: squamous cell carcinoma. Bold values represent p-value ≤0.05.

Table 3. Nodal involvement at presentation by T-stage and size in squamous cell carcinoma of the nasal cavity, and T-stage in maxillary sinus. Reference standard (T2 glottic without supra/subglottic involvement =6.2%). p > 0.05.

		% Nodal involvement (n)	p-Value (comparedto reference standard)	Levels athighest risk	Contralateral at risk
Nasal cavity	T1	4.0% (400)	NS	N/A	N/A
	T2	9.8% (112)	NS	N/A	N/A
	T3	10.3% (68)	NS	N/A	N/A
	T4a	22.0% (100)	<0.001	Facial*, I, II	<0.001
	T4b	22.6% (53)	<0.001	II	0.331**
	≤2 cm	5.2% (211)	NS	N/A	N/A
	>2 cm	12.8% (522)	0.007	I	0.021
Maxillary sinus	T1	8.2% (49)	NS	N/A	N/A
	T2	18.6% (43)	0.002	I, II	0.280
	T3	19.6% (143)	<0.001	RP*, I, II	0.016
	T4a	21.4% (192)	<0.001	I, II	<0.001
	T4b	26.8% (123)	<0.001	I, II, III	<0.001

NS: not statistically significant; RP: retropharyngeal/parapharyngeal. p > 0.05, demarcated in bold font.

*Nodal level possibly at increased involvement risk, but not statistically significant compared to reference; **consider size criteria to determine contralateral neck treatment.

Figure 2. Nodal levels at clinically significant risk for (a) T4a SCC of the nasal cavity, (b) T4b SCC of the nasal cavity, (c) > 2 cm SCC of the nasal cavity, (d) T2 SCC of the maxillary sinus, (e) T3 SCC of the maxillary sinus, (f) T4a SCC of the maxillary sinus, (g) T4b SCC of the maxillary sinus. (+) denotes p < 0.05 compared to reference standard representing nodal levels to be included in treatment fields. (−) denotes p > 0.05 and therefore nodal levels commonly to be excluded from elective fields.

SCC: squamous cell carcinoma.