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Peer-reviewedCC BYInternational archives of otorhinolaryngology

Orbital Apex Involvement in Sinonasal Intestinal-Type Adenocarcinoma: Impact on Distant Metastasis and Mortality.

  • António Andrade1,2
  • José Maria Sousa3,4
  • José Alberto Fernandes1,2,5
  • Ricardo Vaz1,6,7
  • Manuel Mendes Leal8
  • Gil Coutinho1,2
8 affiliations
  1. 1Department of OtorhinolaryngologyUnidade Local de Saúde São JoãoPortoPortugal.
  2. 2Unit of OtorhinolaryngologyDepartment of Surgery and PhysiologyFaculty of Medicine, Universidade do PortoPortoPortugal.
  3. 3Department of NeuroradiologyUnidade Local de Saúde São JoãoPortoPortugal.
  4. 4Center for Research on Health Technology and Services/Health Research Network (CINTESIS@RISE), Faculty of Medicine, Universidade do PortoPortoPortugal.
  5. 5Department of OtorhinolaryngologyUnidade Local de Saúde de Trás-os-Montes e Alto DouroVila RealPortugal.
  6. 6Department of BiomedicineUnit of Anatomy, Faculty of Medicine, Universidade do PortoPortoPortugal.
  7. 7NeuroGen Research Group, Center for Research on Health Technology and Services (CINTESIS), Faculty of Medicine, Universidade do PortoPortoPortugal.
  8. 8Department of OtorhinolaryngologyHospital Companhia União Fabril (CUF) TrindadePortoPortugal.
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Abstract

Introduction

Sinonasal intestinal-type adenocarcinoma (ITAC) is often diagnosed at advanced stages. Prognosis is strongly influenced by tumor extension into critical anatomical regions contiguous with the orbit and skull base, where achieving negative margins is challenging.Objective

To identify predictors of distant metastasis and disease-specific mortality in patients with ITAC, focusing on involvement of critical anatomical structures.Methods

Retrospective analysis of ITAC cases diagnosed between 2010 and 2024 at a tertiary center. Data on clinical presentation, imaging, histopathology, treatment modalities, and outcomes were collected. Uni- and multivariate analyses were performed to identify predictors of distant metastasis and disease-specific mortality.Results

Thirty-four ITAC cases were included. Distant metastasis occurred in 21.2% of cases; orbital apex ( p = 0.007) and pterygopalatine fossa ( p = 0.034) involvement were significant in univariate analysis, with only orbital apex remaining significant in multivariate analysis ( p = 0.024). Regarding ITAC-specific mortality, orbital apex involvement ( p = 0.002), relapse ( p = 0.043), and adjuvant radiotherapy ( p = 0.045) were associated factors, with radiotherapy showing a protective effect. Multivariate analysis confirmed orbital apex as a predictor of mortality ( p = 0.002), while adjuvant radiotherapy had a borderline association ( p = 0.050).Conclusion

Orbital apex involvement independently signals high risk of distant metastasis and disease-specific death in ITAC; such patients merit individualized, intensified multimodal management. Adjuvant radiotherapy may confer a protective benefit, particularly in advanced-stage disease.

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Cite

BibTeXRIS
BibTeX
@article{andrade2026orbital,
  title = {{Orbital Apex Involvement in Sinonasal Intestinal-Type Adenocarcinoma: Impact on Distant Metastasis and Mortality.}},
  author = {António Andrade and José Maria Sousa and José Alberto Fernandes and Ricardo Vaz and Manuel Mendes Leal and Gil Coutinho},
  journal = {International archives of otorhinolaryngology},
  year = {2026},
  month = jul,
  doi = {10.1055/s-0046-1825833},
  url = {https://europepmc.org/article/MED/42921621},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Orbital Apex Involvement in Sinonasal Intestinal-Type Adenocarcinoma: Impact on Distant Metastasis and Mortality.
AU  - António Andrade
AU  - José Maria Sousa
AU  - José Alberto Fernandes
AU  - Ricardo Vaz
AU  - Manuel Mendes Leal
AU  - Gil Coutinho
PY  - 2026
DA  - 2026/07/01
JO  - International archives of otorhinolaryngology
DO  - 10.1055/s-0046-1825833
UR  - https://europepmc.org/article/MED/42921621
AB  - Introduction  Sinonasal intestinal-type adenocarcinoma (ITAC) is often diagnosed at advanced stages. Prognosis is strongly influenced by tumor extension into critical anatomical regions contiguous with the orbit and skull base, where achieving negative margins is challenging.Objective  To identify predictors of distant metastasis and disease-specific mortality in patients with ITAC, focusing on involvement of critical anatomical structures.Methods  Retrospective analysis of ITAC cases diagnosed between 2010 and 2024 at a tertiary center. Data on clinical presentation, imaging, histopathology, treatment modalities, and outcomes were collected. Uni- and multivariate analyses were performed to identify predictors of distant metastasis and disease-specific mortality.Results  Thirty-four ITAC cases were included. Distant metastasis occurred in 21.2% of cases; orbital apex ( p = 0.007) and pterygopalatine fossa ( p = 0.034) involvement were significant in univariate analysis, with only orbital apex remaining significant in multivariate analysis ( p = 0.024). Regarding ITAC-specific mortality, orbital apex involvement ( p = 0.002), relapse ( p = 0.043), and adjuvant radiotherapy ( p = 0.045) were associated factors, with radiotherapy showing a protective effect. Multivariate analysis confirmed orbital apex as a predictor of mortality ( p = 0.002), while adjuvant radiotherapy had a borderline association ( p = 0.050).Conclusion  Orbital apex involvement independently signals high risk of distant metastasis and disease-specific death in ITAC; such patients merit individualized, intensified multimodal management. Adjuvant radiotherapy may confer a protective benefit, particularly in advanced-stage disease.
SN  - 1809-9777
SN  - 1809-4864
ER  -