Treatment Modalities and Survival Outcomes for Sinonasal Diffuse Large B-Cell Lymphoma

Laryngoscope. 2021 Nov;131(11):E2727-E2735. doi: 10.1002/lary.29584. Epub 2021 Apr 26.


Objectives/hypothesis: This study utilizes a large population national database to comprehensively analyze prognosticators and overall survival (OS) outcomes of varying treatment modalities in a large cohort of sinonasal diffuse large B-cell lymphoma (SN-DLBCL) patients.

Study design: Retrospective database study.

Methods: The National Cancer Database was queried for all SN-DLBCL cases diagnosed from 2004 to 2015. Kaplan-Meier log-rank test determined differences in OS based on clinical covariates. Cox proportional-hazards analysis was used to determine clinical and sociodemographic covariates predictive of mortality.

Results: A total of 2,073 SN-DLBCL patients were included, consisting of 48% female with a mean age of 66.0 ± 16.2 years. Overall, 82% of patients were Caucasian, 74% had early-stage disease, and 49% had primary tumors in the paranasal sinuses. Early-stage patients were more likely to receive multi-agent chemoradiotherapy compared to multi-agent chemotherapy alone (P < .001). Multivariable Cox proportional-hazards analysis revealed chemoradiotherapy to confer significantly greater OS improvements than chemotherapy alone (hazard ratio [HR]: 0.61; P < .001). However, subset analysis of late-stage patients demonstrated no significant differences in OS between these treatment modalities (P = .245). On multivariable analysis of chemotherapy patients treated post-2012, immunotherapy (HR = 0.51; P = .024) demonstrated significant OS benefits. However, subset analysis showed no significant advantage in OS with administering immunotherapy for late-stage patients (P = .326). Lastly, for all patients treated post-2012, those receiving immunotherapy had significantly improved OS compared to those not receiving immunotherapy (P < .001).

Conclusions: Treatment protocol selection differs between early- and late-stage SN-DLBCL patients. Early-stage patients receiving chemotherapy may benefit from immunotherapy as part of their treatment paradigm.

Level of evidence: 3 Laryngoscope, 131:E2727-E2735, 2021.

Keywords: B-cell lymphoma; National Cancer Data Base; Sinonasal; chemoradiotherapy; immunotherapy; overall survival; treatment.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use
  • Chemoradiotherapy / methods*
  • Combined Modality Therapy / methods*
  • Female
  • Humans
  • Immunotherapy / methods
  • Lymphoma, Large B-Cell, Diffuse / diagnosis*
  • Lymphoma, Large B-Cell, Diffuse / mortality
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Paranasal Sinus Neoplasms / ethnology
  • Paranasal Sinus Neoplasms / pathology*
  • Progression-Free Survival
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Analysis
  • Treatment Outcome


  • Antineoplastic Agents