Lymph node metastases in malignant tumors of the paranasal sinuses: prognostic value and treatment

Objective: To assess the frequency of nodal involvement and its prognostic value in malignant tumors of the paranasal sinuses, particularly in maxillary sinus squamous cell carcinoma. Design: Retrospective review. Setting: Tertiary cancer center. Patients: The medical records of 704 consecutive patients surgically treated for malignant tumors of the paranasal sinuses from January 1968 to March 2003 were reviewed. The tumors were staged according to American Joint Committee on Cancer-International Union Against Cancer 2002 classification. Only patients with clinically positive nodes underwent a neck dissection. Main Outcome Measures: Lymph node metastases (at presentation or during follow-up, occurring alone, or with concurrent local recurrence and/or distant metastasis). Also analyzed were local recurrence (occurring alone or with concurrent distant metastasis), distant metastasis (occurring alone), and overall survival. Results: The tumor site was the ethmoid sinus in 305 cases and maxillary sinus in 399 cases. At baseline, 5 patients (1.6%) in the ethmoid sinus group and 33 (8.3%) in the maxillary sinus group presented with positive nodes (P<.001); during follow-up, nodal recurrences (alone or simultaneous with T and/or M recurrence) occurred in 15 and 51 patients, respectively, and the corresponding 5-year incidence estimates were 4.3% and 12.5% (P=.001). The highest incidence of node metastases was found in maxillary sinus squamous cell carcinoma, particularly in T2 tumors. Five-year overall survival estimates were 45.3% for patients with N0 tumors and 0% for those with N+ (N1, N2, or N3) ethmoid sinus tumors, and 50.6% and 16.8%, respectively, for patients with maxillary sinus tumors. Conclusions: Lymph node metastases are a poor prognostic factor for patients with malignant tumors of the paranasal sinuses. The incidence of these metastases is low, particularly in ethmoid sinus tumors. A prophylactic treatment of the neck in patients with N0 tumors (surgery or radiotherapy) might be considered in T2 squamous cell carcinoma of the maxillary sinus and in undifferentiated carcinoma of the ethmoid sinus. ©2008 American Medical Association. All rights reserved.