Prognostic factors in sinonasal tumors involving the anterior skull base.

Background: Anterior craniofacial resection is a standardized procedure for the treatment of ethmoid and frontal orbital tumors with intracranial invasion.

Methods: A retrospective review of 100 patients with sinonasal tumors involving the anterior skull base who underwent combined craniofacial surgery at the Hospital Central de Asturias.

Results: The most frequent pathologic entity was adenocarcinoma (53 cases) and other epithelial tumors (29 cases). Five-year actuarial survival according to the Kaplan-Meier method was 40%. Factors such as involvement of surgical margins, orbital periosteum involvement, frontal sinus invasion, or spread into the dura had no significant effect on survival. Survival, however, was affected by the histologic findings of the tumor (p=.03), brain involvement (p=.04), deep soft tissue involvement of the orbit (p=.003), involvement of the sphenoid sinus (p=.001), previous treatment (p=.05), and postoperative recurrence (p=.0000). Neither the INT staging system nor the UICC system showed statistical prognostic significance. After multivariate analysis and Cox regression analysis, only recurrence after craniofacial resection, involvement of soft tissues of the orbit, and invasion of the sphenoid sinus significantly influenced survival.

Conclusions: Standard staging systems did not show statistical prognostic significance. Only involvement of some critical areas was reliable as predictor of an unfavorable outcome.