xRead - Nasal Obstruction (September 2024) Full Articles

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tissue of origin and benign versus malignant histology. 17 Given the large variability in pathology and epidemiology of benign neoplasms, this section will predominantly focus on malignant neoplasms. Malignant tumors of the nasal cavity and paranasal sinuses are relatively rare compared to other malignancies of the head and neck region. SNM is approximated to comprise 3%–5% of all head and neck can cers and less than 1% of all malignancies overall. 20–22 Due to low incidence and large variety of histologic subtypes, true incidence and prevalence estimates have been difficult to accurately measure until recently, with the introduc tion of large national epidemiologic surveillance programs. Some of the largest studies to date have utilized the Surveil lance, Epidemiology, and End Results (SEER) database (population-based) through the U.S. National Program of Cancer Registries and the Center of Disease Control’s National Cancer DataBase (NCDB) (hospital-based). 23,24 Comparable programs exist in Europe and have been sim ilarly utilized to study epidemiology of sinonasal tumors, such as European Cancer Registry (EUROCARE) and Ital ian Network of Cancer Registries (AIRTUM). 25–27 Despite these efforts, our understanding of the epidemiology of SNM continues to be limited by the lack of accurate, gran ular, disease-specific, and reliable cancer data in many countries. 22,26,28 Based on the SEER dataset epidemiologic studies, the estimated incidence of SNM in the United States is approx imately 0.6–0.8 cases per 100,000 population per year during the 1973–2011 period. 23,29,30 Globally, of the coun tries for which incidence data on sinonasal cancer were available, the average reported annual incidence was com parable, with 0.1–0.5 per 100,000 in males and 0.2–0.5 per 100,000 in females. 28 Incidence appears to be higher in Asia and Africa than in the United States and Europe, espe cially among Japanese men. 31–34 Examination of gender demographics across continents revealed a predominance of male cases within every region. 26 Osteomas are the most common benign tumors of the sinonasal tract and are reportedly present on 1% of routine sinus radiographic studies. 35 Other fibroosseous tumors, such as fibrous dysplasia and ossifying fibroma, are also relatively common, with estimated incidence of 1 per 10,000 patients. 19 Benign sinonasal papillomas, which make up to 4% of all sinonasal tumors, have a higher but relatively comparable estimated annual inci dence to sinonasal malignancies of 0.7–2.3 per 100,000 patients. 36,37 IPs, the most aggressive subtype of benign nasal papillomas, frequently present in the fifth and sixth decades of life and are more common in male subjects, with a 3 to 1 male to female ratio. 35 Vascular benign sinonasal tumors include JNA (estimated incidence of 1 per 150,000), lobular capillary hemagniomas, and sinonasal glomangiopericytomas. 19,38 There are numerous

other rarer benign neoplasms and their epidemiology is under active investigation. 17 Malignant sinonasal tumors appears to be more com mon among males across all populations and subsites, with age-normalized incidence rate ratio of males to females varying from 1.3 to 2.5. 26,28–30 Multiple population-based studies for SNM have confirmed the increasing incidence with age, with mean at diagnosis of 62–66 years in men and 66–70 years in women, but the range varies widely. 29,39 Within the US population, these tumors were most com mon in White individuals (80%–82%), followed by Black patients (9%). 29,40 Understanding the racial and demo graphic differences in SNM is important because racial differences and age appear to be associated with the rates of nodal metastasis, as well as overall survival (OS) and disease-specific survival (DSS). 41–43 Compared with White patients, Black patients and American Indian/Alaskan Natives exhibit increased mortality when controlling for other factors, and non-White patients were more likely to be diagnosed at a younger age in the United States. Race and ethnic background also appear to be associated with the patient’s likelihood to receive surgical intervention when recommended. 44 Malignant epithelial neoplasms are the most frequent subtypes across all demographics and subsites, represent ing over 75% of all SNM. Sinonasal SCC represents the vast majority of cancers (reported range 33%–52%), fol lowed by adenocarcinoma (13%–24%), ONB (6%–10%), and ACC (6%–17%). 28,30,39,45 Until recently, most research has focused on SCC and adenocarcinoma. Rarer histological subtypes like SNUC, SNEC, and sarcomas subtypes are under active investigation. The estimated prevalence of these tumors is highly variable—assessed to be around 13% for sarcoma subtypes, 7%–9% for melanoma, 10% for lym phoma, and 3%–14% for SNUC. 22,30,46–49 The majority of all SNM appear to localize to the nasal cavity (reported range 44%–46%), followed by maxillary sinus (29%–40%) and ethmoid cavity (5%–10%). 29,30,39 With some variation, these trends by histology and anatomic location seem to be consistent across North and South America, Europe, and Asia. 28,50 Over the last 30–40 years, the overall global inci dence of SNM has remained stable or showed incremental decrease. 28,30,39 However, it does appear that there is varia tion based on histologic subtypes and region. For example, in the United States there was an observed modest but statistically significant decline in the overall incidence of SCC, but not overall or other SNM, between 1973 and 2009. 32 During the same timeframe, many countries in Europe and Hong Kong reported a decrease in overall incidence. 28 One major epidemiologic study showed that, while the incidence of sinonasal SCC has decreased over time, the incidence of other cancers, including mucosal