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Occult Nodal Involvement in Sinonasal Squamous Cell Carcinoma
Samer T Elsamna1, Aman M Patel2, Ibraheem Shaikh2
1Department of Otolaryngology-Head & Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida.
American Journal of Rhinology & Allergy
|August 26, 2025
Summary
Occult nodal involvement (ONI) is present in 10.9% of sinonasal squamous cell carcinoma (SNSCC) patients and negatively impacts survival. Lymphovascular invasion (LVI) is the primary predictor of ONI, suggesting elective neck dissection may benefit these patients.
Area of Science:
- Oncology
- Head and Neck Surgery
- Cancer Research
Background:
- Sinonasal squamous cell carcinoma (SNSCC) is an aggressive cancer.
- Elective neck dissection (END) is not standard for SNSCC, but occult nodal involvement (ONI) may occur.
- Understanding ONI incidence and impact is crucial for treatment decisions.
Purpose of the Study:
- To evaluate the incidence of occult nodal involvement (ONI) in sinonasal squamous cell carcinoma (SNSCC).
- To identify factors associated with ONI.
- To assess the impact of ONI on patient survival.
Main Methods:
- Analysis of the National Cancer Database (2004-2016) for SNSCC patients.
- Inclusion of patient demographics, clinicopathology, and treatment data.
- Application of univariate/multivariate logistic regression and Kaplan-Meier analyses for ONI prediction and survival assessment.
Main Results:
- Occult nodal involvement (ONI) was identified in 10.9% of 522 SNSCC patients.
- ONI was a significant negative prognostic factor, reducing 3-year survival from 65% to 35%.
- Lymphovascular invasion (LVI) was the sole predictor of ONI (OR: 6.75), with ONI rates reaching 31.4% in patients with LVI.
Conclusions:
- Occult nodal involvement (ONI) affects over 10% of sinonasal squamous cell carcinoma (SNSCC) cases and worsens prognosis.
- Lymphovascular invasion (LVI) is a key predictor for ONI.
- Patients with LVI may benefit from elective neck dissection (END) for improved outcomes.
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