Radiological Tumor Calcification in Sinonasal Adenocarcinoma: Prevalence and Prognostic Implications

Radiological intratumoral calcifications in sinonasal adenocarcinoma have been scarcely investigated. This study aimed to assess their prevalence and evaluate their potential prognostic significance and to examine its association with surgical resectability.

We conducted a retrospective single-center study including patients treated with curative intent for sinonasal adenocarcinoma. Clinical, pathological, treatment, and computed tomography (CT) data were reviewed. Intratumoral diffuse calcifications were assessed on preoperative CT. Associations with tumor characteristics, surgical outcomes, and survival were analyzed using appropriate statistical methods, including Cox proportional hazards models.

Ninety-six patients were included. Intratumoral calcifications were identified in 24 patients (25%). Compared with patients without calcifications, those with calcifications more frequently had locally advanced tumors (pT3-4: 79.2% vs. 47.2%, p = 0.013; pT4: 62.5% vs. 31.9%, p = 0.025), were more likely to receive induction chemotherapy (33.3% vs. 9.7%, p = 0.015), and had a higher rate of incomplete resection (R2: 20.0% vs. 1.5%, p = 0.007). Histological subtype and differentiation grade were similar between groups. The association with R2 resection persisted after adjustment for pT stage (penalized logistic regression: OR 7.74, 95% CI 1.26-82.61; p = 0.026). In univariable analysis, calcifications were associated with worse disease-free survival (HR 2.36, 95% CI 1.23-4.54; p = 0.010), but this association did not persist after adjustment for pT stage (HR 1.47, 95% CI 0.76-2.88; p = 0.26) or in multivariable analysis (HR 1.41, 95% CI 0.70-2.85; p = 0.34). Calcifications were not associated with overall survival.

Intratumoral radiological calcifications were present in 25% of sinonasal adenocarcinomas and were associated with more advanced local disease and a higher risk of incomplete resection. Although associated with poorer disease-free survival in unadjusted analyses, this effect was attenuated after adjustment for tumor stage. These findings suggest that calcifications primarily reflect local tumor extent; although not an independent survival factor, their independent association with incomplete resection may make them a useful preoperative marker of surgical difficulty.

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