Affiliation:
1. Department of Otolaryngology‐Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus Ohio U.S.A.
2. Department of Otolaryngology‐Head and Neck Surgery Tanta University Tanta Egypt
3. Department of Public Health The Ohio State University Columbus Ohio U.S.A.
4. Internal Medicine, Division of Medical Oncology The Ohio State University Wexner Medical Center Columbus Ohio U.S.A.
Abstract
ObjectiveTo comprehensively analyze reported cases of nasolacrimal squamous cell carcinoma (NLSCC), focusing on risk factors, treatment modalities, and outcomes. Additionally, investigate the impact of human Papillomavirus (HPV) status and histopathological subtypes' impact on prognosis.Data SourcesPubmed, Embase.Review MethodsWe conducted a systematic literature review to identify relevant studies reporting cases of NLSCC. The review methods adhered to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. The final update was performed on May 31, 2023.ResultsThe 72 studies included a total of 313 participants (mean age: 55; 60% male). Longer symptom duration (44.1 ± 59.2 months) correlated with recurrence (p = 0.004), and males exhibited higher mortality rates (19.6% vs. 2.4% in females, p = 0.01). The overall survival (OS) rate among all patients was 87.1%. Basaloid NLSCC had a worse death outcome (p ≤ 0.001). HPV‐positive cases showed comparable OS, recurrence, and metastasis rates to the general population (p = 0.917, 0.851, 0.07, respectively). Comparing treatment approaches (surgery, surgery with adjuvant radiation, chemoradiotherapy [CRT] followed by surgery), no significant differences in 5 and 10‐year OS rates or recurrence were observed (p = 0.4, 0.24, respectively), but 5‐year metastasis events were significant (p = 0.024). Eye exenteration rates were 31.1%, 20%, and 0% for the respective treatments (p = 0.089). Induction chemotherapy saved four cases from potential exenteration with favorable prognosis.ConclusionEarly detection and diagnosis are of utmost importance in the management of NLSCC. Regardless of the treatment approach, HPV‐related NLSCC demonstrated similar outcomes to the general population. Basaloid histology represents the worst subtype in terms of prognosis. Limited adjuvant CRT cases showed improved outcomes and induction chemotherapy's importance was emphasized in recent literature and our shared experience. Laryngoscope, 134:3892–3902, 2024