Risk of second primary malignancy in patients with sinonasal tumors:
a population-based cohort study
Ashwin Ganti, BA
, Max A. Plitt, MD
Pete S. Batra, MD, FACS
and Bobby A. Tajudeen, MD
Background: The 5-year overall survival rate for patients
with sinonasal cancers has remained around 50% for the
last 3 decades. Prior studies on head and neck cancers have
suggested that 1 reason for poor survival is the frequent
development of second primary malignancies (SPMs). The
purpose of this study is to assess overall and site-speciﬁc
risks of SPM following treatment of sinonasal malignancy.
Methods: A retrospective, population-based cohort study
was performed on 2614 patients in the Surveillance, Epi-
demiology, and End Results (SEER) database who were di-
agnosed with primary sinonasal malignancy between 1973
and 2014. Standardized incidence ratios (SIRs) and absolute
excess risks (AERs) were calculated to assess risk of SPM
relative to incidence in the general population.
Results: A total of 422 (16.1%) patients with primary
sinonasal malignancies developed a total of 480 SPMs.
This cohort had a signiﬁcantly higher frequency of SPMs
than expected in the general population (SIR 1.32; 95%
conﬁdence interval [CI], 1.20 to 1.44; AER 53.41). Site-
speciﬁc analyses of SIRs suggested highest risk of malig-
nancy in the sinonasal tract (SIR 75.64; 95% CI, 53.53 to
103.83; AER 17.22), followed by bone, eye and orbit, oral cav-
ity and pharynx, and lung and mediastinum.
Conclusion: Patients with history of sinonasal cancer are
at signiﬁcantly increased risk of developing an SPM. Care-
ful monitoring for development of additional tumors may
2018 ARS-AAOA, LLC.
head and neck; sinus tumors; paranasal sinus neoplasms;
malignancy; second primary cancer
Ganti A, Pli MA, Kuan EC, Kuhar HN, Batra PS, Tajudeen
BA. Risk of second primary malignancy in patients with
sinonasal tumors: a population-based cohort study. Int Fo-
rum Allergy Rhinol. 2018;8:756–762.
alignancies of the nasal cavity and paranasal sinuses
are rare and represent only 3% of all cancers of the
head and neck.
These tumors are comprised of varied
histology, including squamous cell carcinoma (SCC), ade-
nocarcinoma, melanoma, lymphoma, and neuroendocrine
tumors such as olfactory neuroblastoma, among others.
Rush Medical College, Rush University, Chicago, IL;
Otorhinolaryngology–Head and Neck Surgery, Rush University Medical
Center, Chicago, IL;
Rush Center for Skull Base and Pituitary Surgery,
Rush University Medical Center, Chicago, IL;
Division of Rhinology,
Department of Otorhinolaryngology–Head and Neck Surgery,
University of Pennsylvania, Philadelphia, PA
Correspondence to: Bobby A. Tajudeen, MD, 1611 W. Harrison St., Suite
550, Chicago, IL 60612; e-mail: firstname.lastname@example.org
Potential conﬂict of interest: P.S.B.: Medtronic (research grant), Acclarent
(consultant), Springer (royalties). B.A.T.: Sinopsys surgical (consultant). All
other authors declare that they have no conﬂicts of interest.
Received: 5 November 2017; Revised: 19 December 2017; Accepted:
10 January 2018
View this article online at wileyonlinelibrary.com.
Sinonasal malignancies are associated with several risk fac-
tors; particularly well known is the relationship between
intestinal-type adenocarcinoma and exposure to wood
dust, leather dust, and other industrial compounds.
Treatment of sinonasal cancers is primarily dictated by tu-
mor histology and typically consists of multimodal therapy
including surgery. However, despite signiﬁcant improve-
ments in surgical technique and chemoradiation protocols,
the overall 5-year survival rate for patients with sinonasal
cancers has remained around 50% for the last 3 decades.
An international pooled analysis conducted by Chuang
in 2008 on over 99,000 patients suggested the
frequent development of second primary malignancies
(SPMs) in patients with cancers of the head and neck as
1 possible reason for the lack of signiﬁcant improvement
in overall survival. Their analysis found that patients di-
agnosed with head and neck cancer had a 36% cumulative
risk of developing an additional malignancy within 20
Subsequent studies have conﬁrmed the increased
risk of SPM in these patients, and have demonstrated that
a second malignancy signiﬁcantly diminishes long-term
International Forum of Allergy & Rhinology, Vol. 8, No. 6, June 2018 756