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Sayed Z, Migliacci JC, Cracchiolo JR, et al. Association of Surgical Approach and Margin Status With Oncologic Outcomes Following Gross Total Resection for Sinonasal Melanoma. JAMA Otolaryngol Head Neck Surg. 2017;143(12):1220–1227. doi:10.1001/jamaoto.2017.2011
What is the association of operative approach and margin status with oncologic outcomes following gross total resection of sinonasal mucosal melanoma?
In this cohort study of 72 patients with nonmetastatic sinonasal mucosal melanoma, no differences in overall survival in patients undergoing endoscopic vs open primary resection were found. Local recurrence rates in patients with positive margins following gross total resection were higher than in patients with negative margins; this was not statistically significant but may be clinically significant.
Select patients with sinonasal mucosal melanoma may benefit from endoscopic surgical approaches whereas positive margin status, although a negative prognostic factor, is likely not the main determinant of survival outcomes.
Sinonasal mucosal melanoma (SMM) is a rare malignant neoplasm characterized by a poor prognosis despite aggressive intervention including wide surgical resection. Margin status has previously been cited as an important prognostic factor for local control and overall survival (OS) in patients who undergo either an open or endoscopic surgical approach. No comparisons have been made, however, in patients who have undergone gross total resection with or without positive margins.
To assess the association of margin status and surgical approach with oncologic outcomes in patients with SMM undergoing gross total resection.
Design, Setting, and Participants
In this cohort study, patients with SMM without evidence of regional or distant disease treated with curative intent in part or full at Memorial Sloan Kettering Cancer Center from 1998 through 2016 were retrospectively assessed. Demographic data, prognostic information, and surgical pathology were reviewed. Operative reports and imaging were used to confirm gross total resection of local disease.
Surgical techniques including open maxillectomy, craniofacial resection, and endoscopic resection.
Main Outcomes and Measures
Three-year local recurrence-free survival (LRFS), disease-free survival (DFS), and OS were calculated using the Kaplan-Meier method. Univariate and multivariable analyses of outcomes were carried out using the Cox proportional hazard regression method.
Seventy-two patients (39 [54%] female; mean [SD] age, 67  years) met the eligibility criteria. Thirty-eight patients (53%) underwent open partial or total maxillectomy with or without ethmoidectomy or sphenoidectomy via a transfacial approach. Fourteen patients (19%) had a more extensive craniofacial approach, and 20 patients (28%) underwent endoscopic resection. The 3-year OS for all patients was 52%. The absolute 3-year difference between patients with open/craniofacial resection vs endoscopic resection for LRFS, DFS, and OS was 11% (95% CI, −21% to 43%), 16% (95% CI, −7% to 39%), and 12% (95% CI, −18% to 41%), respectively. The absolute 3-year difference between patients with a negative margin and patients with a positive margin for LRFS, DFS, and OS was 18% (95% CI, −9% to 45%), 5% (95% CI, −17% to 27%), and 15% (95% CI, −9% to 39%), respectively. Multivariable analysis revealed that none of the adjusted variables (margin status, tumor stage, or surgical approach) were significantly associated with OS.
Conclusions and Relevance
Outcomes for patients with SMM remain poor regardless of operative approach or postoperative margin status.
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