title: Prognostic Indicators for Salvage Surgery of Recurrent Sinonasal Malignancy.
abstract: OBJECTIVE
  Identify prognostic factors after salvage surgery for recurrent sinonasal malignancy (SNM).
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  University of Pittsburgh Medical Center.
  
  
  METHODS
  Forty-two patients who underwent curative surgery for locally recurrent SNM ± adjuvant therapy from June 5, 2000, to December 19, 2012. Patients without follow-up were excluded.
  
  
  METHODS
  Chart review with established prognostic indicators for primary malignancies. Statistical analysis included Kaplan-Meier log-rank test, Fisher's exact test, Student's t test, and Cox regression.
  
  
  RESULTS
  Forty-two patients met inclusion criteria: 38.5% developed a second recurrence, and 21.4% had metastases following treatment. The average disease-free interval (DFI) was 26.9 months (range, 2-90 months). DFI was significantly affected by ethmoid versus nonethmoid site (P = .049), histology (P = .012), carotid artery involvement (P = .008), perineural extension (P = .006), and clival invasion (P = .015). The overall survival rates at 6 months, 12 months, and 5 years following surgery were 83.3%, 69%, and 47.6%, respectively. Survival was affected by histology (P = .014), stratified grade (P = .042), tumor extension into the orbit (P = .019), carotid artery (P = .001), perineural space (P = .028), and clivus (P = .022). Complications occurred in 28.6% of patients and were associated with histology (P = .04). Length of hospital stay related to treatment was affected by histology (P = .009), grade (P = .013), and postoperative complication (P < .001). The median percentage of time hospitalized was 8%, and 43% of patients who died within 12 months spent >10% of their remaining days in the hospital.
  
  
  CONCLUSIONS
  High-risk histologic subtype (melanoma, sinonasal undifferentiated carcinoma, adenocarcinoma, neuroendocrine cancer, sarcoma, and squamous cell carcinoma), grade, and orbital and skull base involvement negatively affect survival and/or DFI for patients with local recurrence of SNM. Improved stratification of patients can be used to guide decision making for patients with recurrent SNM and to avoid inappropriate surgery.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA djk73@pitt.edu.
authors.forename: Daniel James
authors.initials: DJ
authors.lastname: Kaplan
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Jee Hong
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Snyderman
mesh_terms: D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D009669:Nose Neoplasms / Q000401:mortality / Q000601:surgery*; D010255:Paranasal Sinus Neoplasms / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate
keywords: prognostic indicators; recurrent sinonasal malignancy; recurrent sinonasal prognosis; treatment algorithm