A multicenter study on occult lymph node metastases in sinonasal malignancies

Surgical interventions for head and neck carcinoma patients with clinically node-negative neck encompass either elective neck dissection (ND) during primary tumor excision or a wait-and-scan approach. For the rare entity of sinonasal malignancies, no standard guideline exists. This study aims to assess the prevalence of occult lymph node metastasis and evaluate the impact of elective ND on recurrence and survival. This retrospective multicenter study included patients with histologically confirmed sinonasal malignancy between 2012 and 2022. Patient-, disease-, and therapy-specific factors were systematically collected and analyzed. The therapeutic approach was based on recommendations from an interdisciplinary head and neck tumor board. A total of 438 patients with a mean age of 62 years was included. Occult metastases were observed in 8.0% of all cN0 patients assessed by objective imaging. Elective ND was performed in 25% of patients. Histologic subtype of squamous cell carcinoma (SCC) was the only pretherapeutic risk factor identified (OR 6.10; p = 0.019). Five-year disease-free survival (DFS) was significantly reduced in patients with occult lymph node metastasis (p < 0.001). This multicenter study demonstrates a comparatively low risk of occult lymph node metastases in sinonasal malignancies, but significantly reduced DFS. The low rate of occult metastases questions the necessity of systematic elective ND. The indication for elective ND should be critically assessed depending on histology.