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Sinonasal Mucosal Melanoma Survival Outcomes, Recurrence Patterns, and Prognostic Factors: A Systematic Literature
Annie J Orr1,2, Rachel Fenberg3,4, Ricardo L Carrau3
1Department of Otolaryngology, The Ohio State University College of Medicine, Columbus, Ohio, United States.
Background:
Sinonasal mucosal melanoma (SNMM) comprises <1% of all head and neck cancers but has one of the highest 5-year mortalities.
Methods:
A systematic review and analysis using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analyses) guidelines was conducted on SNMM survival, recurrence, and prognostic factors.
Results:
A total of 2,379 abstracts were reviewed resulting in 90 studies describing 3347 SNMM patients. Patients were 49.65% male and 66.5 years old. Surgery plus radiation therapy, followed by surgery only, then radiation only were the most common treatments. Chemotherapy and immunotherapy were used in 418 patients and 101 respectively. The 2-, 3-, and 5-year overall survivals are 55.97, 40.09, and 30.35%, respectively. The 5-year disease-free survival and disease-specific survival are 25.56 and 38.04%. The 5-year local, regional, and distant recurrence-free survivals are 42.35, 81.64, and 44.65%. Mean survival after diagnosis was 26.99 months. Local ( n = 650), regional ( n = 226), and distant ( n = 723) failure presented after 19.36, 6.35, and 12.42 months. Sites of metastasis were lung, liver, bone, brain, skin, kidney, and adrenal glands. Distant metastases, disease in the paranasal sinuses, and higher stage were noted to have worse survival outcomes. Positive margins did not significantly impact overall survival in 11/12 studies.
Conclusion:
Overall survival over 20 years has remained poor with 70% of patients deceased in 5 years. About half of patients will develop distant failure and will thereafter rapidly decline. These data indicate need for advances in treatment of SNMM and new efforts with targeted immunotherapy offer a promising avenue toward improving survival outcomes.
Insights
Sinonasal mucosal melanoma (SNMM) has a high mortality rate, with 70% of patients dying within 5 years. Advances in treatment, particularly targeted immunotherapy, are needed to improve survival outcomes for this rare cancer.
Area of Science:
- Oncology
- Head and Neck Surgery
- Cancer Research
Background:
- Sinonasal mucosal melanoma (SNMM) is a rare cancer, accounting for less than 1% of head and neck malignancies.
- SNMM is associated with a high 5-year mortality rate, underscoring the need for improved understanding and treatment.
Purpose of the Study:
- To systematically review and analyze survival, recurrence patterns, and prognostic factors in SNMM.
- To identify key factors influencing patient outcomes in SNMM.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines.
- Analysis of 90 studies encompassing 3347 SNMM patients, examining treatment modalities, survival rates, and recurrence data.
Main Results:
- The 5-year overall survival for SNMM is poor at 30.35%.
- Distant metastasis is common (44.65% recurrence-free survival at 5 years) and associated with worse outcomes.
- Surgery with radiation therapy was the most common treatment, but positive margins did not significantly impact overall survival in most studies.
Conclusions:
- Overall survival for SNMM remains critically low, with a significant proportion of patients experiencing distant failure.
- Current treatment strategies have not substantially improved long-term survival.
- Targeted immunotherapy presents a promising future direction for enhancing SNMM treatment efficacy and patient survival.
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