Given the low prevalence of the pathology, the study included the registration of the current 103 cases of MSC (T2-4N0-2M0) in patients treated at the ENT Oncology Department of Dnipropetrovsk Regional Clinical Hospital named after І.І. Mechnikov for a long multiyear period (2011 - 2017) and was of prospective character in terms of dynamic observation.
From a total sample of the study which included 66 men (64.08%) and 37 women (35.92%) with an average age of 55.97 years (95% CI 53.15 - 58.79), 12 patients with stage II were examined (11.65%), 59 - with stage III (57.28%) and 32 - with stage IV (31.07%). The study included patients with a prevalence of tumor process at the stage of T2 – 13 patients (12.62%), T3 – 58 (56.31%), T4 -32 (31.07%); N0 – 80 patients (77.67%), N1 –20 (19.42%), N2 – 3 (2.91%). Almost in half of the subjects (44.66%) T3N0M0 stage was noted.
Typical squamous cell carcinoma (SCC) was observed in most of the examined (88.35%), the largest proportion of patients had moderately differentiated cancer (50.49%) by the degree of histological differentiation, in 60.19% of the examined - non-keratinized variants of the tumor were determined, every fifth patient (21.36%) had papillomas. A large proportion of subjects showed signs of aggressive course and adverse outcomes of the tumor - invasive tumor growth (68.93%), metastases (22.33%) and recurrence (11.65%).
Bone invasion was observed in almost all atypical forms of MSC (p = 0.007), to a greater extent (86.84%) it was determined at a low degree of histological differentiation of the tumor (p = 0.011). The frequency of metastasis was associated with the morphological variant of cancer (V = 0.37; p = 0.031) and a decrease in the degree of histological differentiation of the tumor (V = 0.51; p <0.001).
The chances of recurrence increased in low-differentiated tumors as compared with highly differentiated by 9.95 times (OR = 9.95 (95% CI 1.54 - 182.61); p = 0.021) in non-keratinized tumors compared to keratinized forms - by 20.54 times (OR = 20.54 (95% CI 1.18 - 357.46); p = 0.038).
The identified clinical and morphological characteristics of patients (age, sex, stage of the disease, the degree of differentiation and keratinization of the tumor, morphological variants, IHC results, bone invasion, etc.) were considered as possible factors influencing the choice of surgical treatment and subsequent survival rate of the patients examined.
Among the studied characteristics of the examined patients, the most significant prognostic markers of potential adverse outcomes and consequences of maxillary sinus cancer, according to the results of the study, were: non-keratizing cancer (chances of bone invasion increase by 2.61 times and by 20.54 times - recurrence; p < 0.05); low degree of tumor differentiation (chances of bone invasion increase by 4.84 times, chances of metastasis - by 27.0 times and recurrence - by 9.95 times ; p <0.05), increased level of MMP-9 expression (chances of bone invasion increase by 32.0) and p63 - more than 56% (increase in chances of metastasis by 29.56 times and of recurrence - by 328.85 times; p <0.001). In combining of several defined clinical and morphological characteristics, the chances of adverse results increase significantly - chances of bone invasion increase by 12.56 times, chances of metastasis - by 16.26 times and recurrence - by 15.71 times (p <0.05).
Various approaches to surgical treatment were used, including radical surgery or radical surgery with simultaneous chemotherapy (CT). Radical surgery was performed in 32 patients (31.07%), complex surgery with simultaneous CT - in 71(68.93%).
The effectiveness of the proposed approach was proved on the basis of analysis of long-term consequences of treatment of patients with maxilla sinus cancer, which showed that the examined patients had an annual survival of 87.36% (95% CI 80.94 - 93.78), a three-year - 42.75% (95% CI 33.2 - 52.3), a five-year - 19.76% (95% CI 12.07 - 27.45) with a median survival - 32.13 (95% CI 27.0 - 53, 0) months, which was statistically significantly better than the results in patients who underwent surgical treatment without the use of this approach at the same period in the Dnipropetrovsk region.
Survival rate analysis confirmed the effectiveness of the approach used to determine the method of surgical treatment, because in the groups divided by different methods of treatment no differences were found (p = 0.622) - in the group of classical surgery, the median survival rate was 32.0 months (95% CI 27.0 - 53.0), in the group of surgery with CT - 30.91 months (95% CI 23.0 - 53.0), which indicates the adequacy of the choice of one of the alternative treatment options.
