Adjuvant Radiotherapy Does Not Improve Overall Survival After Negative Margin Resection of Sinonasal...

BackgroundEpithelial-myoepithelial carcinoma of the sinonasal tract is rare, and optimal postoperative management remains unclear, particularly regarding the role of adjuvant radiotherapy.ObjectiveTo evaluate associations between surgical margin status, adjuvant radiotherapy, insurance status, and overall survival (OS) in patients with epithelial-myoepithelial carcinoma of the sinonasal tract.MethodsThe National Cancer Database (2004-2020) was queried for patients with epithelial-myoepithelial carcinoma arising in sinonasal subsites (ICD-O 8562). Demographic, tumor, and treatment variables were analyzed for 81 patients. OS was estimated using the Kaplan-Meier analysis with log-rank testing. Cox proportional hazards models were used to evaluate associations between treatment modality, margin status, insurance status, and OS.ResultsMean age was 64.2 years; 56.8% were female. Surgery was performed in 69/81 patients (85.2%); 51 had documented margin status (37 negative, 14 positive). Overall 1-, 5-, and 10-year OS were 95.0%, 76.3%, and 44.9%, respectively. Negative-margin resection was associated with superior OS compared with positive margins (log-rank p = .002). Among patients with negative margins, adjuvant radiotherapy was not associated with improved OS (log-rank p = .82). Insurance-related differences in OS were observed (p = .002).ConclusionIn epithelial-myoepithelial carcinoma of the sinonasal tract, achievement of negative surgical margins is the principal determinant of overall survival. Adjuvant radiotherapy following negative-margin resection was not associated with improved overall survival in this cohort.