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Abstract：
OBJECTIVE: Maxillary cancers are rare and aggressive tumors, which can spread beyond the sinus bony walls. Preoperative assessment of infiltration of maxillary sinus floor (MSF) is paramount for surgical planning, as palatomaxillary demolition significantly impacts patients\' quality of life. This study investigates the challenges involved in the preoperative and intraoperative evaluation of MSF infiltration and analyzes its prognostic relevance.
METHODS: Retrospective case series.
METHODS: A retrospective review of patients treated for sinonasal malignancies at a single Institution was performed. Patients receiving surgical-based treatment with curative intent for primary maxillary sinus cancers, between January 2000 and November 2019, were included.
RESULTS: A cohort of 118 patients was analyzed. By comparing intraoperative findings (endoscopic assessment and frozen sections) with preoperative radiological assessment, diagnostic changes with regard to MSF infiltration were found in 27.1% (32/118 cases). MSF infiltration negatively affected the prognosis in both univariate and multivariate analyses in the overall population. In the subgroup of pT1-T3 tumors, MSF infiltration was significantly associated with reduced overall (P = .012), disease-free (P = .011), and distant recurrence-free (P = .002) survival rates. Conversely, pT classification was not able to stratify patients according to prognosis, mainly because early-staged cancers (pT1-T2) with MSF infiltration showed reduced survival rates, similar to those observed in pT3 cancers.
CONCLUSIONS: Preoperative imaging should be integrated with intraoperative findings based on endoscopic inspection and frozen sections. Future studies are required to investigate the opportunity to incorporate MSF infiltration in the TNM staging system, considering its crucial role in defining the extent of surgery and its potential as prognosticator.
METHODS: 4 Laryngoscope, 2021.
METHODS: Retrospective case series.
METHODS: A retrospective review of patients treated for sinonasal malignancies at a single Institution was performed. Patients receiving surgical-based treatment with curative intent for primary maxillary sinus cancers, between January 2000 and November 2019, were included.
RESULTS: A cohort of 118 patients was analyzed. By comparing intraoperative findings (endoscopic assessment and frozen sections) with preoperative radiological assessment, diagnostic changes with regard to MSF infiltration were found in 27.1% (32/118 cases). MSF infiltration negatively affected the prognosis in both univariate and multivariate analyses in the overall population. In the subgroup of pT1-T3 tumors, MSF infiltration was significantly associated with reduced overall (P = .012), disease-free (P = .011), and distant recurrence-free (P = .002) survival rates. Conversely, pT classification was not able to stratify patients according to prognosis, mainly because early-staged cancers (pT1-T2) with MSF infiltration showed reduced survival rates, similar to those observed in pT3 cancers.
CONCLUSIONS: Preoperative imaging should be integrated with intraoperative findings based on endoscopic inspection and frozen sections. Future studies are required to investigate the opportunity to incorporate MSF infiltration in the TNM staging system, considering its crucial role in defining the extent of surgery and its potential as prognosticator.
METHODS: 4 Laryngoscope, 2021.
摘要：
目的：上颌癌是一种罕见的侵袭性肿瘤，可以扩散到鼻窦骨壁之外。上颌窦底（MSF）浸润的术前评估对于手术计划至关重要，因为腭腋窝拆除显著影响患者的生活质量。这项研究调查了MSF浸润的术前和术中评估所涉及的挑战，并分析了其预后相关性。
方法：回顾性病例系列。
方法：对单个机构接受鼻窦恶性肿瘤治疗的患者进行回顾性分析。接受基于手术治疗的原发性上颌窦癌患者，2000年1月至2019年11月，包括在内。
结果：分析了118例患者的队列。通过比较术中发现（内窥镜评估和冰冻切片）与术前放射学评估，27.1％（32/118例）发现无国界医生浸润的诊断变化。在总体人群的单变量和多变量分析中，MSF浸润均对预后产生负面影响。在pT1-T3肿瘤亚组中，MSF浸润与总体下降显著相关(P=.012)，无病（P=.011），无远处复发生存率（P=0.002）。相反，pT分类无法根据预后对患者进行分层，主要是因为MSF浸润的早期癌症（pT1-T2）存活率降低，与在pT3癌症中观察到的相似。
结论：术前影像学检查应结合内镜检查和冰冻切片的术中发现。未来的研究需要调查将无国界医生渗透纳入TNM分期系统的机会，考虑到它在确定手术范围中的关键作用及其作为预后者的潜力。
方法：4喉镜，2021年。
方法：回顾性病例系列。
方法：对单个机构接受鼻窦恶性肿瘤治疗的患者进行回顾性分析。接受基于手术治疗的原发性上颌窦癌患者，2000年1月至2019年11月，包括在内。
结果：分析了118例患者的队列。通过比较术中发现（内窥镜评估和冰冻切片）与术前放射学评估，27.1％（32/118例）发现无国界医生浸润的诊断变化。在总体人群的单变量和多变量分析中，MSF浸润均对预后产生负面影响。在pT1-T3肿瘤亚组中，MSF浸润与总体下降显著相关(P=.012)，无病（P=.011），无远处复发生存率（P=0.002）。相反，pT分类无法根据预后对患者进行分层，主要是因为MSF浸润的早期癌症（pT1-T2）存活率降低，与在pT3癌症中观察到的相似。
结论：术前影像学检查应结合内镜检查和冰冻切片的术中发现。未来的研究需要调查将无国界医生渗透纳入TNM分期系统的机会，考虑到它在确定手术范围中的关键作用及其作为预后者的潜力。
方法：4喉镜，2021年。
