Impact of facility volume on survival in primary endoscopic surgery for sinonasal squamous cell carcinoma

Benjamin F Bitner; Nolan A Huck; Pooya Khosravi; Sina J Torabi; Eric H Abello; Khodayar Goshtasbi; Edward C Kuan

doi:10.1016/j.amjoto.2023.104133

Impact of facility volume on survival in primary endoscopic surgery for sinonasal squamous cell carcinoma

Am J Otolaryngol. 2024 Mar-Apr;45(2):104133. doi: 10.1016/j.amjoto.2023.104133. Epub 2023 Nov 27.

Authors

Benjamin F Bitner¹, Nolan A Huck², Pooya Khosravi², Sina J Torabi², Eric H Abello², Khodayar Goshtasbi², Edward C Kuan²

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, United States of America. Electronic address: bbitner@hs.uci.edu.
² Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, United States of America.

PMID: 38039908
DOI: 10.1016/j.amjoto.2023.104133

Abstract

Objectives: To evaluate the impact of facility volume on outcomes following primary endoscopic surgical management of sinonasal squamous cell carcinoma (SNSCC).

Methods: The 2010-2016 National Cancer DataBase (NCDB) was queried for patients diagnosed with T1-T4a SNSCC surgically treated endoscopically as the primary treatment modality. Factors associated with overall survival (OS) were evaluated, including facility volume.

Results: A total of 330 patients who underwent endoscopic surgical management of SNSCC were treated at 356 unique facilities designated as either low-volume (LVC; treating 1-2 cases; 0-75th percentile), intermediate-volume centers (IVC; 3-4 cases total; 75th-90th percentile), or 144 high-volume (HVC; treating 5+ cases total; >90th percentile) centers. HVC treated patients with higher T staging (42.1 % vs. 29.8 %) and tumors in the maxillary sinus (26.9 % vs. 13.2 %) and ethmoid sinus (10.3 % vs. ≤8.3 %), while LVCs treated lower T stage tumors (70.2 % vs. 57.9 %) and tumors that were located in the nasal cavity (70.2-78.5 % vs. 62.8 %). On multivariable analysis, factors associated with decreased OS included higher T stage (T3/T4a vs. T1/T2; OR 1.92, 95 % CI 1.06-3.47) and older age (>65 vs. <65; OR 2.69, 95 % CI 1.62-4.49). Cases treated at high-volume centers were not associated with a higher likelihood of OS when compared to low-volume centers (OR 0.70, 95 % CI 0.36-1.35).

Conclusions: HVC are treating more primary tumors of the maxillary and ethmoid sinuses and tumors with higher T stages with endoscopic approaches, although this does not appear to be associated with increased OS.

Short summary: Sinonasal squamous cell carcinoma (SNSCC) presents late in disease process with poor prognosis. We investigated the impact of facility volume on outcomes following endoscopic treatment of SNSCC. High-volume centers treat more advanced and complex disease with comparable OS.

Keywords: Academic facility; Endoscopic; Hospital volume; National Cancer DataBase; Outcomes; Overall survival; Sinonasal squamous cell carcinoma.

MeSH terms

Carcinoma, Squamous Cell* / pathology
Ethmoid Sinus / surgery
Humans
Nasal Cavity / pathology
Paranasal Sinus Neoplasms* / pathology
Paranasal Sinus Neoplasms* / surgery
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck