Author(s)
Arash Abiri, BS
Tyler Yasaka, BS
Khodayar Goshtasbi, BS
Michael Berger, MD
Edward C. Kuan, MD MBA
Affiliation(s)
University of California, Irvine School of Medicine;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to explain the benefits of adjuvant immunotherapy in treating sinonasal mucosal melanoma and be able to discuss notable prognostics factors for patient survival. Objectives: To analyze associations between treatment modalities and patient survival in sinonasal mucosal melanoma (SMM). Study Design: Retrospective analysis of the National Cancer Database (NCDB). Methods: Patients diagnosed with SMM in 2004-2015 were identified from NCDB. Those who did not undergo surgical resection or immunotherapy were excluded. Log rank tests evaluated the relationship between overall survival (OS) and different treatment methods or insurance providers. Hazard ratios (HRs) of various demographic and clinical factors were assessed using a Cox proportional hazards model. Results: Of 815 patients with SMM, 89% underwent surgery only (SO), 3% immunotherapy only (IO), and 8% adjuvant immunotherapy (SI). The 5 year OS was 23%, with a mean of 29 ± 28 months. There was no significant difference (p=0.63) in OS between SO (22%), IO (24%), and SR (29%). Additionally, patients with private insurance were found to have higher OS than those with government insurance (p=0.003). Multivariate analysis demonstrated that females had higher OS than males (HR=0.84, p=0.04). Moreover, a Charleson/Deyo (CD) score of 1 was associated with greater OS (HR=0.75, p=0.02), while a CD score greater than 2 (HR=2.53, p=0.02), positive surgical margins (HR=1.40, p=0.001) and melanomas originating from the paranasal sinuses (HR=1.62, p<0.001) were negative prognostic factors for OS. Conclusions: Supplementing surgery with adjuvant immunotherapy does not significantly improve OS in SMM patients when compared to surgery or immunotherapy alone. Certain demographic and clinical factors such as sex, tumor origin, surgical margin, CD score, and insurance were associated with differences in OS of SMM.