xRead - Nasal Obstruction (September 2024) Full Articles

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ICAR SINONASAL TUMORS

sinonasal melanoma and ONB, has gradually increased between 1973 and 2006. 30 It is possible that the gradual increase in rarer histologies is associated with improved detection. 30 Mortality rates for SNM across all subtypes have also been decreasing over time in most of the countries for which reliable data were available, especially with the increased implementation of multimodal therapy. 28,45,51–53 Decreased incidence and improved survival can be explained by several other factors, including the under lying pathophysiology and improved understanding for environmental contributors to disease development. 39,54 Robust evidence for increased risk of SNM development exists with occupational exposure to formaldehyde, hydro carbons, industrial textiles, construction (woodworking in particular), and nickel and chromium compounds, especially for adenocarcinoma. 34,54–56 Cigarette smoking and tobacco use are also established risk factors for devel opment of SNM, especially for SCC. 57,58 Pooled analysis of the European studies showed an odds ratio (OR) of 1.7 (95% confidence interval [CI] 1.2–2.6) for current smokers developing SNSCC. 58 With smoking rates decreasing in many developed countries since the 1970s, it is plausible to presume that reduction in incidence of SCC may be attributed to decreased tobacco consumption. 28,59 With sinonasal adenocarcinoma attributed to possible occupa tional hazards, public efforts to reduce environmental and occupational exposures in the Netherlands, for example, led to the overall reduction of adenocarcinoma incidence between 1973 and 2009. 34,60 The potential role of HPV in the development of sinonasal SCC is an area of active investigation. It is approximated that about 20%–30% of SNSCC are HPV associated, and HPV occurs only rarely in other sinonasal cancers. 61,62 However, it does appear that HPV association may be associated with improved survival. 61,63,64 Cur rently, only a minority of patients with SNSCC are tested for HPV, but testing is becoming more routine. 62 Routine HPV testing in the future may improve our understanding of role of human papillomavirus in development of SNM and impact on survival. 61,64,65 Increased efforts in can cer detection and surveillance, improved understanding of pathophysiology and treatment modalities, and further public health efforts may continue to reduce the incidence of sinonasal tumors and improve survival of these rare but aggressive malignancies. V GENERAL RISK FACTORS Sinonasal tumors are relatively rare, but they have the sec ond highest occupational attributable fraction (AF) of all types of cancer. 66 Predisposing factors include exposure to

wood dust, industrial carcinogens, leather, textiles, organic fibers, and heavy metals such as nickel and chromium. The role of alcohol and tobacco in sinonasal cancer is less than other head and neck malignancies. 67,68 A Age SNM is a condition affecting patients of any age (Table V.1). However, the majority are older, with two thirds being over 50 years of age at diagnosis (e.g., mucosal melanoma more often affecting the elderly). 16 The incidence increases from 0.1 to 0.3 cases per 100,000 population in the first decade of life to 7 per 100,000 in the eighth decade. 32,54,60 Initial reports on ONB describe bimodal age distribu tion, while others reported a unimodal distribution. 69–71 However, according to the latest nationwide population based data analysis results on 876 patients, the incidence of ONBs is steadily rising with a peak in the fifth to sixth decades, suggesting a unimodal age distribution. 72 The United States showed the highest proportion of patients under 55 years of age with SNM diagnoses at over 30%, followed by Eastern Europe at around 27%. One fac tor that may explain the increased proportion of younger patients, particularly in Eastern Europe, is the greater prevalence of tobacco use among minors in this region. 26 B Genetic sex SNM is twice as common in males as females, where males (58.6%) outnumbered females at every anatomical site (Table V.2). 16 This may be attributable to the etio logical association with occupational exposure to wood and leather dust particles in male-dominated trades. 29 The exception is ACC, where female predominance is reported. 30,73–79 It is hypothesized that ACC may be hormonally influenced, with studies showing significant estrogen receptor (ER) or progesterone receptor (PR) expression. 30,74 In contrast, others noted the ER-beta subtype or PR expression alone. 80,81 C Ethnicity The prevalence is eightfold higher in Caucasians, who accounted for 70%–80% of cases and outnumbered all other races at every anatomical site. 29,67,68 This trend appears to be similar in the pediatric population. 82 AF is a proportion of all cases in the population that can be attributed to exposure (e.g., AF for wood dust is 0.2 or 20%). Values of AF close to 1 (100%) indicate that both the relative risk is high and the risk factor is prevalent. In such