Nationwide Analysis of Olfactory Neuroblastoma in Japan: Evolving Treatment Approaches and Prognostic Outcomes

Nationwide Analysis of Olfactory Neuroblastoma in Japan: Evolving Treatment Approaches and Prognostic Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nationwide Analysis of Olfactory Neuroblastoma in Japan: Evolving Treatment Approaches and Prognostic Outcomes Mariko Sekimizu, Takuya Mikoshiba, Ryoto Nagai, Naoaki Ishikawa, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6323600/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Olfactory neuroblastoma (ONB) is a rare and malignant tumor of the nasal cavity. This study aimed to analyze cases of ONB from the Head and Neck Cancer Registry of Japan. Methods : We identified 346 patients with ONB from 90,885 head and neck cancer registrations between 2011 and 2019. Data on demographics, TNM stage, and treatment modalities (surgery, radiotherapy, and chemotherapy) were collected. Patients were divided into early (2011–2015) and late (2016–2019) groups to assess changes in treatment patterns. Survival was analyzed in 95 patients with available follow-up data. Results : T4 lesions were frequently observed, and 234 patients (67.6%) underwent surgery-based treatment, typically combined with radiotherapy. Over time, the use of endoscopic approaches increased significantly, replacing open cranial base surgery. Among the 95 patients with evaluable follow-up data, the 5-year overall survival (OS) rate was 85.1%, while the recurrence-free survival (RFS) rate was 62.7%. Patients younger than 60 years and female patients had improved OS. Postoperative radiotherapy improved RFS but did not impact OS. Chemotherapy was frequently used in cases requiring extensive cranial base resections. Conclusions : This large-scale, multicenter study provides insight into ONB treatment trends and outcomes in Japan. Although the 5-year prognosis is favorable, a significant risk of recurrence remains, emphasizing the need for optimized long-term treatment strategies. The widespread adoption of endoscopic surgery suggests shift toward less invasive approaches. Further prospective studies are needed to refine therapeutic options and improve long-term outcomes for patients with ONB. Olfactory neuroblastoma prognosis skull base surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Olfactory neuroblastoma (ONB) is a rare malignant tumor originating from the olfactory mucosa, accounting for 3–6% of nasal sinus malignancies [ 1 ]. The standard treatment for ONB is surgical resection followed by postoperative radiation therapy. Traditionally, a frontal craniotomy for open cranial base surgery was the primary surgical approach for anterior skull base tumor resection. However, with the widespread adoption of endoscopic endonasal surgery, treatment for ONB has become less invasive. Despite high tumor control rates achieved through surgery followed by postoperative radiotherapy, the long-term prognosis remains poor, with a 10-year disease-free survival rate of approximately 57.1–70.8%[ 2 , 3 ]. Additionally, although endoscopic techniques are now widely implemented, studies have not demonstrated significant improvements in survival rates [ 4 ]. Various histological tumor types, including ONB, can develop in the nasal cavity and paranasal sinuses, many of which are rare. Consequently, large-scale treatment reports are scarce worldwide. Most single-institution reports include only a few dozen cases, highlighting the need for broader-scale analyses. In this study, we analyzed cases of ONB registered in the Head and Neck Cancer Registry of Japan [ 5 ] and report findings on the current state of ONB treatment in Japan. Since 2012, the Japan Society for Head and Neck Cancer has maintained a nationwide registry for head and neck malignancies. Nearly all major institutions treating head and neck cancers across Japan participate in this project. A prognostic follow-up survey was initiated in 2017, making this registry one of Japan’s most representative databases for real-world clinical practice. With the goal of tracking all registered cases, this dataset represents Japan’s only comprehensive resource for head and neck malignancies. Given the long-term nature of this registry, we analyzed differences in treatment strategies based on the time of registration. Additionally, we conducted a survival analysis for a subset of patients with available prognostic data to identify factors influencing survival outcomes. Patients and Methods This study used data from the Head and Neck Cancer Registry of Japan, which was maintained by the Japan Society for Head and Neck Cancer, which collect data on head and neck cancer diagnoses in Japan and conducts annual surveys. This study was approved by the Institutional Ethics Committee (20231116) and the Japan Society for Head and Neck Cancer Ethics Committee (2-23-3). Our investigation focused on patients diagnosed and registered between 2011 and 2019. Among the 90,885 head and neck cancer cases recorded, 346 were patients with ONB (Fig. 1 ). Patient demographics and initial treatment data were analyzed for all 346 cases. The modified Kadish staging [ 6 ] and/or Dulguerov staging [ 7 ] are typically used to assess ONB progression. However, these classifications were not included in the registry’s input system. Therefore, tumor staging data were recorded using the conventional TNM classification applied to all sinonasal cancers. Additionally, the Hyams classification, commonly used for the pathological evaluation of ONB, was not included in the registry data. Surgical input options are provided in Supplemental Table 1. The option of endoscopic skull base surgery was added in 2016. For this study, surgical procedures were categorized into endoscopic skull base surgery, open skull base surgery, and maxillectomy. The treatment period was divided into two phases: early (2011–2015, 117 patients) and late (2016–2019, 229 patients). Patient characteristics and treatment methods were compared between these two periods. The higher number of patients in the later period can be attributed to increased number of facilities participating in the research. The chi-square test was used to compare the two groups. Among the 346 patients with ONB, 117 were registered between 2011 and 2015. Of these, eight received only palliative treatment, and 14 lacked prognostic data. As a result, 95 patients were included in the final prognostic analysis, as the registry conducts 5-year follow-up outcome surveys. Survival rates were calculated using Kaplan-Meier curves, and log-rank tests were used to compare prognostic factors. A p-value of less than 0.05 was considered statistically significant. All statistical analyses were performed using SPSS version 29.0. Results [Analysis of All Registered Cases] Tables 1 and 2 summarize the patient demographics. Overall, 208 patients (60.1%) were male, and 138 (39.9%) were female, with a median age of 55 years (range 0–88). The primary tumor sites were as follows: nasal cavity in 209 patients (60.4%), ethmoid sinus in 40 (11.6%), maxillary sinus in 5 (1.4%), sphenoid sinus in 3 (0.8%), posterior nasal aperture and posterior end of the nasal septum in 3 (0.8%), and nasal sinus not otherwise specified (NOS) in 86 (24.9%). Regarding TNM classification, T1 disease was identified in 21 patients (6.1%), T2 in 46 (13.3%), T3 in 21 (6.1%), and T4 (including T4, T4a, and T4b) in 118 (34.1%). An additional 140 cases (40.5%) did not have a specified T classification. Because the registry did not differentiate between T4, T4a, and T4b, were categorized as T4 in this analysis. For N classification, 214 patients (61.8%) were classified as N0, 21 (6.1%) had metastatic lymph nodes, and 111 (32.1%) had no specification. Three patients presented with distant metastases (M1) at diagnosis (one with lung metastasis and two with liver metastases). Regarding treatment strategies, radical treatment was selected for 301 patients, 20 patients received palliative care, and treatment information was missing for 25 patients (Table 3). Among those who underwent radical treatment, 234 patients (77.7%) underwent surgery with or without additional treatment: 172 (57.1%) received surgical resection followed by postoperative radiotherapy, and 52 (17.3%) underwent surgery without perioperative treatment. Preoperative irradiation was administered in four cases. Chemotherapy was administered before or after surgery in 21 cases. The surgical treatment procedures included endoscopic skull base surgery (105 cases), open skull base surgery (51 cases), maxillectomy (24 cases), and other or unspecified procedures (54 cases) (Table 3). For radical treatment, 56 patients (23.9%) received radiation-based therapy, including particle beam therapy in 31 cases and conventional X-ray radiation in 25. Among these, radiation alone was administered in 20 cases, chemoradiation therapy in 12, and radiation (or chemoradiation) combined with systemic chemotherapy in 24. Systemic chemotherapy alone was used as radical treatment in seven cases. [Comparison between the early and late treatment periods] Patients enrolled between 2011 and 2015 (early period, 117 patients) were compared with those enrolled between 2016 and 2019 (late period, 229 patients). The median ages for the early and late periods were 59 and 54 years, respectively. There were no notable differences in the distribution of N classification. However, for T classification, excluding cases with unknown T classification, the comparison between T1 and all other T categories (T2/3/4) reached statistical significance (p = 0.037), indicating a higher proportion of T1 lesions in the late period. Radical treatment was performed in 102 patients (87.2%) during the early period and in 199 patients (86.9%) during the late period (Table 3). In the early period, surgical resection with perioperative treatment was selected for 71 patients (60.7%), whereas 163 patients (71.2%) underwent this approach in the late period (Table 3, Fig. 2). The proportion of patients undergoing surgical treatment increased significantly in the late period (p = 0.019). In the early period, 32.4% of cases involved open cranial base surgery, while only 4.2% underwent endoscopic surgery (Table 3). In the late period, the proportion of open cranial base surgery decreased to 17.2%, while endoscopic surgery increased to 62.6%. Although the registry’s "Other" category may have limited the accuracy of surgical procedure classification, these data suggest a clear shift toward endoscopic approaches over time. [Prognostic analysis for 95 cases] Patient characteristics and treatment details are presented in Table 4. Among the 95 included patients, 54 (56.8%) were male, and 41 (43.2%) were female, with a median age of 60 years (range 20–88). T4 disease was the most common (37 cases, 38.9%), while T-stage information was unavailable for 35 cases (36.8%). Sixty-three patients (66.3%) had no lymph node metastases (N0), six had N1 or N2 disease, and 26 (27.4%) had no N-stage information. Regarding treatment, 64 patients underwent surgery with perioperative treatment (surgery-based treatment group), while 25 were treated with radiation-based therapy (particle beam therapy in 15 and X-ray therapy in 10), with or without chemotherapy. Among patients who received systemic chemotherapy as part of curative treatment, 7 of 22 (31.8%) who underwent extensive cranial base surgery also received systemic chemotherapy. In contrast, among the 42 patients who underwent other surgical procedures, only 4 (9.5%) received chemotherapy. Systemic chemotherapy was significantly more common in cases requiring more extensive resection (p = 0.02) (Supplemental Table 2). Of the 95 patients analyzed, 34 (35.8%) experienced recurrence, including 16 cases of local recurrence at the primary site, 15 cases of cervical lymph node metastases, and five cases of distant metastases (including overlapping recurrences). The median follow-up period for surviving patients was 68.8 months (range 0–92.8). At the five-year follow-up, 74 patients were alive, 15 had died, and six were lost to follow-up. The five-year overall survival (5y-OS) rate was 85.1%, and the five-year recurrence-free survival (5y-RFS) rate was 62.7% (Fig. 3). Univariate analyses based on patient characteristics and treatment modalities are presented in Tables 5 and 6. Patients younger than 60 years had significantly better 5y-OS than those aged 60 or older (5y-OS of 95.3% vs. 75.5%, respectively; p = 0.015). Female patients had significantly better survival than male patients (5y-OS of 94.7% vs. 77.5%, respectively; p = 0.011). Although patients with advanced disease (T4, N1/2/3, or Stage IV) had worse 5y-OS and 5y-RFS outcomes, these differences were not statistically significant. Regarding primary treatment (Table.6 and Fig. 4), the surgery-based group had a significantly higher 5y-RFS than the radiation-based group (5y-RFS of 69.4% vs. 48.9%, respectively; p = 0.010). Within the surgery-based group, patients who underwent surgery combined with radiotherapy had significantly better 5y-RFS than those who underwent surgery alone (5y-RFS of 79.6% vs. 40.8%, respectively; p = 0.030) (Fig. 5). Although patients who underwent surgery with systemic chemotherapy had higher 5y-OS and 5y-RFS than those who did not receive chemotherapy, this difference did not reach statistical significance. Discussion This study provided a comprehensive analysis of the characteristics of patients with ONB in Japan through a large-scale, multicenter observational study. Similar to findings in other countries, ONB was slightly more common in males, with peak incidence occurring in patients in their 50s and 60s [ 8 – 10 ]. The primary site of ONB is typically the olfactory cleft or upper nasal cavity, but ectopic occurrences have also been reported. In a systematic review spanning 1955 to 2021, Lui et al. found that the ethmoid sinus accounted for 25% of cases, the maxillary sinus for 25%, and the sphenoid sinus for 16% [ 11 ]. The distribution of cases in this study was consistent with previous reports. This study demonstrated that ONB was frequently diagnosed at an advanced stage (T4). Among all cases analyzed, 34.1% were classified as T4. When excluding the 140 cases with an unknown T classification, the proportion increased to 57.3%, indicating a high frequency of advanced-stage disease. This finding aligns with previous large case series, which have reported that approximately half of ONB cases fall into Kadish C or Dulguerov staging T4 categories [ 12 , 13 ]. Additionally, when comparing the early and late registration periods, the proportion of early-stage ONB increased in the later period. This tend suggests the possibility of earlier tumor detection, potentially due to the increasing use of flexible fiberoptic endoscopy and improved access to imaging studies in Japan. This study's 5y-OS and 5y-RFS rates were 85.1% and 62.7%, respectively, which were generally consistent with previous reports. The prognosis of ONB varies across studies, with 5y-OS rates ranging from 63–89%. However, ONB is considered to have a relatively favorable prognosis among sinonasal malignancies [ 10 , 12 , 14 , 15 ]. Despite this, long-term recurrence and metastasis remain significant clinical concerns. A single-center long-term follow-up study reported that the OS rate declined from 85.6% at 5 years to 62.7% at 10 years, while the RFS rate decreased from 65.8% at 5 years to 50% at 10 years [ 12 ]. Similarly, another study reported a 5y-OS of 83.4% and a 10-year OS of 76.1%, with disease-free survival rates of 80% at 5 years and 62.8% at 10 years [ 14 ]. While the short-term prognosis for ONB is favorable, recurrence and subsequent mortality increase over time. Therefore, improving the prognosis of ONB, requires not only strengthening current primary treatment approaches but also developing effective preoperative and postoperative adjuvant therapies. Several prognostic factors for ONB have been previously reported, particularly in cancer registry data from the United States. These studies have identified age, gender, Kadish staging, Hyams classification, lymph node metastasis, and resection margins as key prognostic indicators [ 13 ]. In this study, the 5y-OS rate was significantly better for patients younger than 60 years and for female patients, while the 5y-RFS rate was significantly higher for those who underwent surgery followed by postoperative radiotherapy. The relationship between age and ONB prognosis remains unclear. While some studies, consistent with our findings have reported poorer outcomes in elderly patients [ 8 ], others suggest that ONB may be more aggressive in younger individuals [ 16 ]. Naturally, older patients are more likely to have comorbidities and reduced physiological reserves, which may limit their ability to tolerate invasive treatments. Similarly, the influence of gender, on ONB prognosis remains inconclusive. Some studies have reported worse outcomes in male patients [ 8 ], while others suggest that male sex may be associated with poorer prognosis due to more advanced disease at presentation [ 17 , 18 ]. However, these differences may be influenced by other factors, such as tumor stage and histological grade. Further research is needed to clarify the role of gender in ONB prognosis. For the treatment of ONB, it is generally accepted that combining surgery with postoperative radiotherapy improves local control and prolongs survival [ 1 , 19 , 20 ]. However, some reports have demonstrated improved local control without a corresponding survival benefit or have suggested that postoperative irradiation should be reserved only for locally advanced cases [ 12 , 21 ]. In the present study, postoperative irradiation improved 5y-RFS but did not significantly influence 5y-OS. This may be due to the relatively short observation period for ONB and missing data in this study. Additionally, this study did not identify T classification, lymph node metastasis, or stage classification as significant prognostic factors. The registry used in this study conducts prognostic follow-ups at the 5-year mark, but does not track outcomes beyond that point, limiting the evaluation of prognostic factors as well as long-term recurrence and metastasis in ONB. In earlier practice, tumor excision predominantly involved an open cranial base approach via a frontal craniotomy. However, with the introduction of endoscopic surgery over the past two decades, transnasal endoscopic skull base surgery has become the standard of care for ONB, due to its superior safety profile and favorable outcomes [ 22 , 23 ]. The study period coincided with this shift in ONB treatment in Japan, transitioning from an era when open cranial base surgery was commonly performed to a period which endoscopic surgery became the standard approach. To evaluate this shift, we divided the study period into early and late phases, demonstrating a higher frequency of endoscopic surgery in the later period. Additionally, the proportion of surgical interventions increased among patients who underwent curative treatment, while the frequency of definitive radiotherapy decreased. This suggests that as endoscopic surgery became more widely adopted in Japan, surgical therapy for ONB was performed more actively. Although endoscopic surgery has reduced surgical invasiveness, some reports have indicated that it has not improved prognosis [ 4 ]. Therefore, to achieve better outcomes for ONB, developing more effective preoperative and postoperative treatment strategies is essential. Strengthening perioperative treatment is a potential option for improving ONB prognosis. Although not statistically significant, the data in this study suggested that patients who received chemotherapy had relatively better survival rates. Many of these patients underwent more extensive surgical procedures, indicating that chemotherapy was more commonly administered in advanced cases. The role of chemotherapy in ONB remains unclear [ 24 ]; however, some studies suggest that systemic chemotherapy may benefit locally advanced or unresectable cases [ 25 , 26 ]. While certain reports suggest that adding chemotherapy to radiotherapy improves prognosis [ 27 , 28 ], systematic reviews have refuted this claim [ 24 ]. Clinical trials are necessary to evaluate the efficacy of chemotherapeutic agents, including molecularly targeted therapies [ 29 , 30 ] and immune checkpoint inhibitors [ 31 ]. Given that ONB is a rare tumor, demonstrating the effectiveness of such treatments will likely require basket trials and other approaches for drug development in rare cancers. This study has several limitations. First, ONB is a rare cancer, making it difficult to accumulate a sufficient number of cases, even in multicenter collaborative studies. While this study analyzed a relatively large dataset of 346 cases, prognosis was assessed only at 5-year intervals, limiting the ability to conduct long-term follow-ups. Given the nature of ONB, this may be insufficient for a comprehensive analysis. Second, the registry used in this study was designed for all types of head and neck cancers and lacks ONB-specific data fields. As a result, widely used classification systems such as Kadish staging and Hyams grading could not be applied. Additionally, the surgical classification in the registry reflects the era of open skull base surgery in which it was established, potentially leading to inaccuracies in distinguishing between open cranial base surgery and endoscopic surgery. In particular, combined endoscopic surgery with open craniotomy was not assumed and may have been classified as open skull base surgery in this study. Another significant limitation is the lack of data on surgical margins, a critical prognostic factor, which further restricts the ability to assess prognosis. Additionally, missing data raises concerns about the accuracy of treatment and survival outcomes. Lastly, as an observational study, this research can only indicate associations rather than determine the optimal treatment strategy. Prospective randomized trials are needed to establish prognostic factors and evaluate the efficacy of different treatment approaches for ONB. Declarations Acknowledgements We thank the Cancer Registry Committee of the Japan Society for Head and Neck Cancer for granting permission to conduct this study. We also extend our deepest gratitude to Japan's head and neck surgeons who contributed to the Head and Neck Cancer Registry of Japan. This work was supported by JSPS KAKENHI Grant Number 24K18554. Data availability The data generated in this study are available in the article. Declarations Conflict of interest: None. References Jethanamest D, Morris LG, Sikora AG, Kutler DI (2007) Esthesioneuroblastoma: a population-based analysis of survival and prognostic factors. Arch Otolaryngol Head Neck Surg 133 (3):276-280. doi:10.1001/archotol.133.3.276 Meerwein CM, Nikolaou G, G HAB, Soyka MB, Holzmann D (2021) Surgery as single-modality treatment for early-stage olfactory neuroblastoma: An institutional experience, systematic review and meta-analysis. Am J Rhinol Allergy 35 (4):525-534. doi:10.1177/1945892420973163 Choby G, Geltzeiler M, Almeida JP, Champagne PO, Chan E, Ciporen J, Chaskes MB, Fernandez-Miranda J, Gardner P, Hwang P, et al (2023) Multicenter survival analysis and application of an olfactory neuroblastoma staging modification incorporating Hyams grade. JAMA Otolaryngol Head Neck surg 149 (9):837-844. doi:10.1001/jamaoto.2023.1939 Vuong HG, Nguyen DD, El-Rassi E, Ngo TNM, Dunn IF (2022) Absence of survival improvement for patients with esthesioneuroblastoma over the past 2 decades: A population-based study. World Neurosurg 157:e245-e253. doi:10.1016/j.wneu.2021.09.139 Kawakita D, Yoshimoto S, Nakamizo M, Kitayama M, Kirita T, Kodaira T, Tomioka T, Kamiyama R, Takahashi H, Nakayama H, Ohyama Y, Murakami Y, Nibu KI (2025) Head and neck cancer registry of Japan. Auris, nasus, larynx 52 (2):122-126. doi:10.1016/j.anl.2025.01.007 Morita A, Ebersold MJ, Olsen KD, Foote RL, Lewis JE, Quast LM (1993) Esthesioneuroblastoma: Prognosis and management. Neurosurgery 32 (5):706-714; discussion 714-715. doi:10.1227/00006123-199305000-00002 Dulguerov P, Calcaterra T (1992) Esthesioneuroblastoma: The UCLA experience 1970-1990. Laryngoscope 102 (8):843-849. doi:10.1288/00005537-199208000-00001 Yin Z, Wang Y, Wu Y, Zhang X, Wang F, Wang P, Tao Z, Yuan Z (2018) Age distribution and age-related outcomes of olfactory neuroblastoma: A population-based analysis. Cancer Manag Res 10:1359-1364. doi:10.2147/CMAR.S151945 Abdelmeguid AS (2018) Olfactory neuroblastoma. Curr Oncol Rep 20 (1):7. doi:10.1007/s11912-018-0661-6 Tosoni A, Di Nunno V, Gatto L, Corradi G, Bartolini S, Ranieri L, Franceschi E (2023) Olfactory neuroblastoma: Diagnosis, management, and current treatment options. Front Oncol 13:1242453. doi:10.3389/fonc.2023.1242453 Lui CG, Badash I, Tang L, Mark ME, Batra PS, Wrobel BB (2024) Ectopic olfactory neuroblastoma: Systematic review of a rare clinical entity among sinonasal tumors. J Neurol Surg B Skull Base 85 (2):109-118. doi:10.1055/a-1993-7790 Abdelmeguid AS, Bell D, Roberts D, Ferrarotto R, Phan J, Su SY, Kupferman M, Raza S, DeMonte F, Hanna E (2022) Long-term outcomes of olfactory neuroblastoma: MD Anderson Cancer Center experience and review of the literature. Laryngoscope 132 (2):290-297. doi:10.1002/lary.29732 Carey RM, Godovchik J, Workman AD, Kuan EC, Parasher AK, Chen J, Palmer JN, Adappa ND, Newman JG, Brant JA (2017) Patient, disease, and treatment factors associated with overall survival in esthesioneuroblastoma. Int Forum Allergy Rhinol 7 (12):1186-1194. doi:10.1002/alr.22027 Rimmer J, Lund VJ, Beale T, Wei WI, Howard D (2014) Olfactory neuroblastoma: A 35-year experience and suggested follow-up protocol. The Laryngoscope 124 (7):1542-1549. doi:10.1002/lary.24562 Diaz EM, Jr., Johnigan RH, 3rd, Pero C, El-Naggar AK, Roberts DB, Barker JL, DeMonte F (2005) Olfactory neuroblastoma: The 22-year experience at one comprehensive cancer center. Head & neck 27 (2):138-149. doi:10.1002/hed.20127 Bisogno G, Soloni P, Conte M, Podda M, Ferrari A, Garaventa A, Luksch R, Cecchetto G (2012) Esthesioneuroblastoma in pediatric and adolescent age. A report from the TREP project in cooperation with the Italian Neuroblastoma and Soft Tissue Sarcoma Committees. BMC Cancer 12:117. doi:10.1186/1471-2407-12-117 Burnham AJ, Burnham PA, Horwitz EM (2021) Survival associations between patient age and treatment modality in olfactory neuroblastoma: A retrospective population-based study. J Clin Med 10 (12). doi:10.3390/jcm10122685 Stokes WA, Camilon PR, Banglawala SM, Nguyen SA, Harvey R, Vandergrift WA, Schlosser RJ (2015) Is sex an independent prognostic factor in esthesioneuroblastoma? Am J Rhinol Allergy 29 (5):369-372. doi:10.2500/ajra.2015.29.4204 De Bonnecaze G, Lepage B, Rimmer J, Al Hawat A, Vairel B, Serrano E, Chaput B, Vergez S (2016) Long-term carcinologic results of advanced esthesioneuroblastoma: A systematic review. Eur Arch Otorhinolaryngol 273 (1):21-26. doi:10.1007/s00405-014-3320-z Mody MD, Saba NF (2020) Multimodal therapy for sinonasal malignancies: Updates and review of current treatment. Curr Treat Options Oncol 21 (1):4. doi:10.1007/s11864-019-0696-4 Konuthula N, Iloreta AM, Miles B, Rhome R, Ozbek U, Genden EM, Posner M, Misiukiewicz K, Govindaraj S, Shrivastava R, Gupta V, Bakst RL (2017) Prognostic significance of Kadish staging in esthesioneuroblastoma: An analysis of the National Cancer Database. Head & neck 39 (10):1962-1968. doi:10.1002/hed.24770 Harvey RJ, Nalavenkata S, Sacks R, Adappa ND, Palmer JN, Purkey MT, Schlosser RJ, Snyderman C, Wang EW, Woodworth BA, Smee R, Havas T, Gallagher R (2017) Survival outcomes for stage-matched endoscopic and open resection of olfactory neuroblastoma. Head Neck 39 (12):2425-2432. doi:10.1002/hed.24912 Barinsky GL, Azmy MC, Kilic S, Grube JG, Baredes S, Hsueh WD, Eloy JA (2021) Comparison of open and endoscopic approaches in the resection of esthesioneuroblastoma. Ann Otol Rhinol Laryngol 130 (2):136-141. doi:10.1177/0003489420939582 Cranmer LD, Chau B, Rockhill JK, Ferreira M, Jr., Liao JJ (2020) Chemotherapy in esthesioneuroblastoma/olfactory neuroblastoma: An analysis of the surveillance epidemiology and end results (SEER) 1973-2015 database. Am J Clin Oncol 43 (3):203-209. doi:10.1097/coc.0000000000000649 Kuan EC, Wang EW, Adappa ND, Beswick DM, London NR, Jr., Su SY, Wang MB, Abuzeid WM, Alexiev B, Alt JA, Antognoni P, Alonso-Basanta M, et al (2024) International consensus statement on allergy and rhinology: Sinonasal rumors. Int Forum Allergy Rhinol 14 (2):149-608. doi:10.1002/alr.23262 Marinelli JP, Janus JR, Van Gompel JJ, Link MJ, Foote RL, Lohse CM, Price KA, Chintakuntlawar AV (2018) Esthesioneuroblastoma with distant metastases: Systematic review and meta-analysis. Head Neck 40 (10):2295-2303. doi:10.1002/hed.25209 Orton A, Boothe D, Evans D, Lloyd S, Monroe MM, Jensen R, Shrieve DC, Hitchcock YJ (2018) Esthesioneuroblastoma: A patterns-of-care and outcomes analysis of the National Cancer Database. Neurosurgery 83 (5):940-947. doi:10.1093/neuros/nyx535 Sun M, Wang K, Qu Y, Zhang J, Zhang S, Chen X, Wang J, Wu R, Zhang Y, Yi J, Xiao J, Xu G, Huang X, Luo J (2020) Long-term analysis of multimodality treatment outcomes and prognosis of esthesioneuroblastomas: A single center results of 138 patients. Radiat Oncol 15 (1):219. doi:10.1186/s13014-020-01667-4 Preusser M, Hutterer M, Sohm M, Koperek O, Elandt K, Dieckmann K, Prayer D, Marosi C (2010) Disease stabilization of progressive olfactory neuroblastoma (esthesioneuroblastoma) under treatment with sunitinib mesylate. J Neurooncol 97 (2):305-308. doi:10.1007/s11060-009-0027-x Gay LM, Kim S, Fedorchak K, Kundranda M, Odia Y, Nangia C, Battiste J, Colon-Otero G, Powell S, Russell J, Elvin JA, Vergilio JA, Suh J, Ali SM, Stephens PJ, Miller VA, Ross JS (2017) Comprehensive genomic profiling of esthesioneuroblastoma reveals additional treatment options. Oncologist 22 (7):834-842. doi:10.1634/theoncologist.2016-0287 Hoshi Y, Enokida T, Tamura S, Nakashima T, Okano S, Fujisawa T, Sato M, Wada A, Tanaka H, Takeshita N, Tanaka N, Onaga R, Kishida T, Uryu H, Sakashita S, Asakage T, Tahara M (2024) Efficacy of anti-PD-1 monotherapy for recurrent or metastatic olfactory neuroblastoma. Front Oncol 14:1379013. doi:10.3389/fonc.2024.1379013 Tables Table 1. Patient characteristics Variable All (346) Early period (117) Late period (229) n (%) n (%) n (%) Age Median (range) 55 (0-88) 59 (20-88) 54 (0-88) Gender Male 208 60.1 65 55.6 143 62.4 Female 138 39.9 52 44.4 86 37.6 Performance Status 0 246 71.1 73 62.4 173 75.5 1 32 9.2 9 7.7 23 10.0 2 7 2 2 1.7 5 2.2 3 2 0.6 0 0 2 0.9 unknown 59 17.1 33 28.2 26 11.4 Table 2. Disease characteristics Variable All (346) Early period (117) Late period (229) n (%) n (%) n (%) Primary site Nasal cavity 209 60.4 67 57.3 142 62 Maxillary sinus 5 1.4 1 0.8 4 1.7 Ethmoid sinus 40 11.6 22 18.8 18 7.9 Sphenoid sinus 3 0.8 1 0.8 2 0.9 Posterior nostril / nasal septum 3 0.8 0 0 3 1.3 Others and NOS 86 24.9 26 22.2 60 26.2 T classification 1 21 6.1 2 1.7 19 8.3 2 46 13.3 15 12.8 31 13.5 3 21 6.1 7 6 14 6.1 4（4, 4a, 4b） 118 34.1 42 35.9 76 33.2 No definition / unknown 140 40.5 51 43.6 89 38.9 N classification 0 214 61.8 70 59.8 144 62.9 1 9 2.6 2 1.7 7 3.1 2 11 3.2 5 4.3 6 2.6 3 1 0.3 0 0 1 0.4 No definition / unknown 111 32.1 40 34.2 71 31 M classification 0 249 72 83 70.9 166 72.5 1 3 0.8 2 1.7 1 0.4 No definition / unknown 94 21.2 32 27.4 62 27.1 Table 3. Treatment characteristics Variable All (346) Early period (117) Late period (229) n (%) n (%) n (%) Treatment policy Radical treatment 301 87 102 87.2 199 86.9 Palliative care 20 5.8 8 6.8 12 5.2 Unknown 25 7.2 7 6.0 18 7.9 Treatment sequence（of radical treatment） Surgery alone 52 17.3 14 13.7 38 19.1 Surgery + RT/CRT 161 53.5 46 45.1 115 57.8 Surgery + RT + Chemo 15 5.0 6 5.9 9 4.5 Surgery + Chemo 6 2.0 5 4.9 1 0.5 Radiation alone 20 6.6 8 7.8 12 6.0 Radiation and Chemo (CRT) 12 4.0 5 4.9 7 3.5 RT/CRT + Chemo 24 8.0 13 12.7 11 5.5 Chemo alone 7 2.3 2 2.0 5 2.5 Unknown 4 1.3 3 2.9 1 0.5 Surgical Procedure Endoscopic skull base surgery 105 44.9 3 4.2 102 62.6 Open skull base surgery 51 21.7 23 32.4 28 17.2 Maxillectomy 24 10.3 4 5.6 20 12.3 Other and Unknown 54 23.1 41 57.7 13 7.9 RT; radiotherapy, CRT; chemoradiotherapy, Chemo; chemotherapy. Treatment sequence in no particular order Table 4. Patient characteristics of 95 cases for prognostic analysis Variable n （%） Age (years) Median (range) 60 (20-88) Gender Male / Female 54 / 41 56.8 / 43.2 T classification 1 / 2 / 3 2 / 14 / 7 2.1 / 14.7 / 7.4 4（4, 4a, 4b） 37 38.9 No definition / unknown 35 36.8 N classification 0 63 66.3 1 / 2 1 / 5 1.1 / 5.3 No definition / unknown 26 27.4 Treatment sequence（of radical treatment） Surgery alone 13 13.7 Surgery + RT/CRT 40 42.1 Surgery + RT + Chemo 8 8.4 Surgery + Chemo 3 3.2 Radiation alone 7 7.4 CRT 5 5.3 RT/CRT + Chemo 13 13.7 Chemo alone 2 2.1 Unknown 4 4.2 RT; radiotherapy, CRT; chemoradiotherapy, Chemo; chemotherapy. Table 5. Univariate analysis by patient characteristics of 95 cases for prognostic analysis n 5y-OS (%) p value 5y-RFS (%) p value All patients 95 85.1 62.7 Age <60 46 95.3 0.015 65.6 0.936 ≥60 49 75.5 59.9 Gender Female 41 94.7 0.011 60.6 0.183 Male 54 77.5 65.5 T classification T1/2/3 23 86.4 0.484 69.1 0.093 T4 37 85.6 47.2 N classification N0 63 85.8 0.248 57.6 0.746 N1/2/3 6 83.3 50 Stage Stage I / II / III 22 90.5 0.197 68.8 0.104 Stage IV 38 82.9 47.4 5y-OS; 5-year overall survival, 5y-RFS; 5-year recurrence free survival. Table 6. Univariate analysis by primary treatment of 95 cases for prognostic analysis n 5y-OS (%) p value 5y-RFS (%) p value Main treatment Surgery-based 64 89.9 0.322 69.4 0.010 Radiation-based 25 77.1 48.9 Post-operative adjuvant therapy with RT/CRT 48 92.9 0.36 79.6 0.030 without RT/CRT 16 80 40.8 Addition of chemotherapy with chemo 11 100.0 0.658 80.0 0.659 without chemo 53 87.7 67.0 5y-OS; 5-year overall survival, 5y-RFS; 5-year recurrence free survival, RT; radiotherapy, CRT; chemoradiotherapy, Chemo; chemotherapy Supplementary Files Supplementaltable.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6323600","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":438286294,"identity":"8b2072c1-3561-45b0-b4b4-d9ddd85805f6","order_by":0,"name":"Mariko Sekimizu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYFACNoYDQJKHTf5g44MPID47sVr4JZgPG84A8ZmJ0AIGkjPY0qR5QCxCWuTb2xIP3ai5J2Nwu8dM2ubXNnk+ZgbGDx9zcGsxOHPswOGcY8U8BnfOGFvn9t02bGNmYJacuQ2PFon0hsM5bAk8BgdyDG/n9txmBGphY+bFo0V+/nOgln9gLQbSlj237QlqYbjBduBwblsCj+SMtCRphh+3EwlqMTiTlnA4ty+Bh5/n8GHD3obbyW3MjM14/SLffsz4c863BHs29sbGBz/+3Lad39588MNHfA5DAYxtYLKBWPUg8IcUxaNgFIyCUTBSAABJNlQEB+VfqwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-1430-991X","institution":"Keio University Hospital: Keio Gijuku Daigaku Byoin","correspondingAuthor":true,"prefix":"","firstName":"Mariko","middleName":"","lastName":"Sekimizu","suffix":""},{"id":438286295,"identity":"441bbdb9-edb0-4f6e-8c23-15d95fefa569","order_by":1,"name":"Takuya Mikoshiba","email":"","orcid":"","institution":"Keio University: Keio Gijuku Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Takuya","middleName":"","lastName":"Mikoshiba","suffix":""},{"id":438286296,"identity":"4baf2a5f-c354-4af2-a7c2-3c88840be398","order_by":2,"name":"Ryoto Nagai","email":"","orcid":"","institution":"Keio University: Keio Gijuku Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Ryoto","middleName":"","lastName":"Nagai","suffix":""},{"id":438286297,"identity":"e04d84a2-40a8-4965-b223-315741bbb806","order_by":3,"name":"Naoaki Ishikawa","email":"","orcid":"","institution":"Keio University: Keio Gijuku Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Naoaki","middleName":"","lastName":"Ishikawa","suffix":""},{"id":438286298,"identity":"e0468fd0-2c3e-4f93-a6c6-88f48fe0ffbc","order_by":4,"name":"Takashi Okada","email":"","orcid":"","institution":"Keio University: Keio Gijuku Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Takashi","middleName":"","lastName":"Okada","suffix":""},{"id":438286299,"identity":"80b0f159-5b0d-40d0-b2b1-832f752f35e5","order_by":5,"name":"Megumi Kitayama","email":"","orcid":"","institution":"Wakayama Medical University: Wakayama Kenritsu Ika Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Megumi","middleName":"","lastName":"Kitayama","suffix":""},{"id":438286300,"identity":"93b0570d-4dac-4467-8f1d-66024027f639","order_by":6,"name":"Daisuke Kawakita","email":"","orcid":"","institution":"Nagoya City University Graduate School of Medical Sciences and Medical School: Nagoya Shiritsu Daigaku Daigakuin Igaku Kenkyuka Igakubu","correspondingAuthor":false,"prefix":"","firstName":"Daisuke","middleName":"","lastName":"Kawakita","suffix":""},{"id":438286301,"identity":"00936540-3565-4675-96cd-f62023cee725","order_by":7,"name":"Ken-ichi Nibu","email":"","orcid":"","institution":"Kobe University: Kobe Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Ken-ichi","middleName":"","lastName":"Nibu","suffix":""},{"id":438286302,"identity":"7bfedbd3-aed5-432b-9bdf-3ab2063edae1","order_by":8,"name":"Seiichi Yoshimoto","email":"","orcid":"","institution":"National Cancer Center Hospital: Kokuritsu Gan Kenkyu Center Chuo Byoin","correspondingAuthor":false,"prefix":"","firstName":"Seiichi","middleName":"","lastName":"Yoshimoto","suffix":""},{"id":438286303,"identity":"98de8035-81a0-4cf5-b38f-1fe12e1ceb1a","order_by":9,"name":"Hiroyuki Ozawa","email":"","orcid":"","institution":"Keio University: Keio Gijuku Daigaku","correspondingAuthor":false,"prefix":"","firstName":"Hiroyuki","middleName":"","lastName":"Ozawa","suffix":""}],"badges":[],"createdAt":"2025-03-27 23:41:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6323600/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6323600/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82132292,"identity":"d77256ba-23f9-4ad1-9914-2aff796d57eb","added_by":"auto","created_at":"2025-05-07 05:43:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28229,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow diagram of this study\u003c/p\u003e\n\u003cp\u003eThis study, initially analyzed 346 cases to examine patient characteristics and surgical procedure selection. For survival analysis, 95 cases with available prognostic data were included.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-6323600/v1/c394fb5d599e2b83c3476d48.png"},{"id":82134879,"identity":"6769b2b5-70f3-49cb-b5d3-a449af9d3d46","added_by":"auto","created_at":"2025-05-07 06:07:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":57885,"visible":true,"origin":"","legend":"\u003cp\u003eTreatment options in the early and late periods.\u003c/p\u003e\n\u003cp\u003eThe treatment options for the two periods are shown. Case where the treatment policy or treatment details were unknown are labeled as “unknown”.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-6323600/v1/e0b2c01b843e5df87e4c542b.png"},{"id":82136777,"identity":"3eb5e77e-f535-4ed7-b124-181029f9865c","added_by":"auto","created_at":"2025-05-07 06:15:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":47282,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival curves of 95 patients\u003c/p\u003e\n\u003cp\u003ea) Overall survival, b) Recurrence-free survival\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-6323600/v1/38144be9438620837d9de253.png"},{"id":82132309,"identity":"897f35c3-6825-4850-a252-8469e4f5dfb8","added_by":"auto","created_at":"2025-05-07 05:43:00","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":73343,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-6323600/v1/11ea363ac23688c6cfb219d9.png"},{"id":82132299,"identity":"50f4cc71-3571-4cb0-b69a-f4f527f855c0","added_by":"auto","created_at":"2025-05-07 05:43:00","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":74536,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Fig5.png","url":"https://assets-eu.researchsquare.com/files/rs-6323600/v1/e42d2c66708c1f1336bf2ec1.png"},{"id":87199508,"identity":"09c7c112-185b-492f-8250-edcfa4272a4a","added_by":"auto","created_at":"2025-07-21 13:02:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1059766,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6323600/v1/d8a52101-8606-4efb-b663-7def239bcba8.pdf"},{"id":82134883,"identity":"489902e5-7086-4da1-a723-9bda8ed9cc18","added_by":"auto","created_at":"2025-05-07 06:07:00","extension":"docx","order_by":10,"title":"","display":"","copyAsset":false,"role":"supplement","size":20043,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaltable.docx","url":"https://assets-eu.researchsquare.com/files/rs-6323600/v1/2808248f4575428ecdc239eb.docx"}],"financialInterests":"","formattedTitle":"Nationwide Analysis of Olfactory Neuroblastoma in Japan: Evolving Treatment Approaches and Prognostic Outcomes","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOlfactory neuroblastoma (ONB) is a rare malignant tumor originating from the olfactory mucosa, accounting for 3\u0026ndash;6% of nasal sinus malignancies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The standard treatment for ONB is surgical resection followed by postoperative radiation therapy. Traditionally, a frontal craniotomy for open cranial base surgery was the primary surgical approach for anterior skull base tumor resection. However, with the widespread adoption of endoscopic endonasal surgery, treatment for ONB has become less invasive. Despite high tumor control rates achieved through surgery followed by postoperative radiotherapy, the long-term prognosis remains poor, with a 10-year disease-free survival rate of approximately 57.1\u0026ndash;70.8%[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Additionally, although endoscopic techniques are now widely implemented, studies have not demonstrated significant improvements in survival rates [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVarious histological tumor types, including ONB, can develop in the nasal cavity and paranasal sinuses, many of which are rare. Consequently, large-scale treatment reports are scarce worldwide. Most single-institution reports include only a few dozen cases, highlighting the need for broader-scale analyses.\u003c/p\u003e \u003cp\u003eIn this study, we analyzed cases of ONB registered in the Head and Neck Cancer Registry of Japan [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and report findings on the current state of ONB treatment in Japan. Since 2012, the Japan Society for Head and Neck Cancer has maintained a nationwide registry for head and neck malignancies. Nearly all major institutions treating head and neck cancers across Japan participate in this project. A prognostic follow-up survey was initiated in 2017, making this registry one of Japan\u0026rsquo;s most representative databases for real-world clinical practice. With the goal of tracking all registered cases, this dataset represents Japan\u0026rsquo;s only comprehensive resource for head and neck malignancies.\u003c/p\u003e \u003cp\u003eGiven the long-term nature of this registry, we analyzed differences in treatment strategies based on the time of registration. Additionally, we conducted a survival analysis for a subset of patients with available prognostic data to identify factors influencing survival outcomes.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003eThis study used data from the Head and Neck Cancer Registry of Japan, which was maintained by the Japan Society for Head and Neck Cancer, which collect data on head and neck cancer diagnoses in Japan and conducts annual surveys. This study was approved by the Institutional Ethics Committee (20231116) and the Japan Society for Head and Neck Cancer Ethics Committee (2-23-3).\u003c/p\u003e \u003cp\u003eOur investigation focused on patients diagnosed and registered between 2011 and 2019. Among the 90,885 head and neck cancer cases recorded, 346 were patients with ONB (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Patient demographics and initial treatment data were analyzed for all 346 cases. The modified Kadish staging [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and/or Dulguerov staging [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] are typically used to assess ONB progression. However, these classifications were not included in the registry\u0026rsquo;s input system. Therefore, tumor staging data were recorded using the conventional TNM classification applied to all sinonasal cancers. Additionally, the Hyams classification, commonly used for the pathological evaluation of ONB, was not included in the registry data. Surgical input options are provided in Supplemental Table\u0026nbsp;1. The option of endoscopic skull base surgery was added in 2016. For this study, surgical procedures were categorized into endoscopic skull base surgery, open skull base surgery, and maxillectomy. The treatment period was divided into two phases: early (2011\u0026ndash;2015, 117 patients) and late (2016\u0026ndash;2019, 229 patients). Patient characteristics and treatment methods were compared between these two periods. The higher number of patients in the later period can be attributed to increased number of facilities participating in the research. The chi-square test was used to compare the two groups.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAmong the 346 patients with ONB, 117 were registered between 2011 and 2015. Of these, eight received only palliative treatment, and 14 lacked prognostic data. As a result, 95 patients were included in the final prognostic analysis, as the registry conducts 5-year follow-up outcome surveys. Survival rates were calculated using Kaplan-Meier curves, and log-rank tests were used to compare prognostic factors. A p-value of less than 0.05 was considered statistically significant. All statistical analyses were performed using SPSS version 29.0.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e[Analysis of All Registered Cases]\u003c/p\u003e\n\u003cp\u003eTables 1 and 2 summarize the patient demographics. Overall, 208 patients (60.1%) were male, and 138 (39.9%) were female, with a median age of 55 years (range 0\u0026ndash;88). The primary tumor sites were as follows: nasal cavity in 209 patients (60.4%), ethmoid sinus in 40 (11.6%), maxillary sinus in 5 (1.4%), sphenoid sinus in 3 (0.8%), posterior nasal aperture and posterior end of the nasal septum in 3 (0.8%), and nasal sinus not otherwise specified (NOS) in 86 (24.9%). Regarding TNM classification, T1 disease was identified in 21 patients (6.1%), T2 in 46 (13.3%), T3 in 21 (6.1%), and T4 (including T4, T4a, and T4b) in 118 (34.1%). An additional 140 cases (40.5%) did not have a specified T classification. Because the registry did not differentiate between T4, T4a, and T4b, were categorized as T4 in this analysis. For N classification, 214 patients (61.8%) were classified as N0, 21 (6.1%) had metastatic lymph nodes, and 111 (32.1%) had no specification. Three patients presented with distant metastases (M1) at diagnosis (one with lung metastasis and two with liver metastases).\u003c/p\u003e\n\u003cp\u003eRegarding treatment strategies, radical treatment was selected for 301 patients, 20 patients received palliative care, and treatment information was missing for 25 patients (Table 3). Among those who underwent radical treatment, 234 patients (77.7%) underwent surgery with or without additional treatment: 172 (57.1%) received surgical resection followed by postoperative radiotherapy, and 52 (17.3%) underwent surgery without perioperative treatment. Preoperative irradiation was administered in four cases. Chemotherapy was administered before or after surgery in 21 cases. The surgical treatment procedures included endoscopic skull base surgery (105 cases), open skull base surgery (51 cases), maxillectomy (24 cases), and other or unspecified procedures (54 cases) (Table 3).\u003c/p\u003e\n\u003cp\u003eFor radical treatment, 56 patients (23.9%) received radiation-based therapy, including particle beam therapy in 31 cases and conventional X-ray radiation in 25. Among these, radiation alone was administered in 20 cases, chemoradiation therapy in 12, and radiation (or chemoradiation) combined with systemic chemotherapy in 24. Systemic chemotherapy alone was used as radical treatment in seven cases.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Comparison between the early and late treatment periods]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients enrolled between 2011 and 2015 (early period, 117 patients) were compared with those enrolled between 2016 and 2019 (late period, 229 patients). The median ages for the early and late periods were 59 and 54 years, respectively. There were no notable differences in the distribution of N classification. However, for T classification, excluding cases with unknown T classification, the comparison between T1 and all other T categories (T2/3/4) reached statistical significance (p = 0.037), indicating a higher proportion of T1 lesions in the late period.\u003c/p\u003e\n\u003cp\u003eRadical treatment was performed in 102 patients (87.2%) during the early period and in 199 patients (86.9%) during the late period (Table 3).\u003c/p\u003e\n\u003cp\u003eIn the early period, surgical resection with perioperative treatment was selected for 71 patients (60.7%), whereas 163 patients (71.2%) underwent this approach in the late period (Table 3, Fig. 2). The proportion of patients undergoing surgical treatment increased significantly in the late period (p = 0.019).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the early period, 32.4% of cases involved open cranial base surgery, while only 4.2% underwent endoscopic surgery (Table 3). In the late period, the proportion of open cranial base surgery decreased to 17.2%, while endoscopic surgery increased to 62.6%. Although the registry\u0026rsquo;s \u0026quot;Other\u0026quot; category may have limited the accuracy of surgical procedure classification, these data suggest a clear shift toward endoscopic approaches over time.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Prognostic analysis for 95 cases]\u003c/p\u003e\n\u003cp\u003ePatient characteristics and treatment details are presented in Table 4. Among the 95 included patients, 54 (56.8%) were male, and 41 (43.2%) were female, with a median age of 60 years (range 20\u0026ndash;88). T4 disease was the most common (37 cases, 38.9%), while T-stage information was unavailable for 35 cases (36.8%). Sixty-three patients (66.3%) had no lymph node metastases (N0), six had N1 or N2 disease, and 26 (27.4%) had no N-stage information.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding treatment, 64 patients underwent surgery with perioperative treatment (surgery-based treatment group), while 25 were treated with radiation-based therapy (particle beam therapy in 15 and X-ray therapy in 10), with or without chemotherapy. Among patients who received systemic chemotherapy as part of curative treatment, 7 of 22 (31.8%) who underwent extensive cranial base surgery also received systemic chemotherapy. In contrast, among the 42 patients who underwent other surgical procedures, only 4 (9.5%) received chemotherapy. Systemic chemotherapy was significantly more common in cases requiring more extensive resection (p = 0.02) (Supplemental Table 2).\u003c/p\u003e\n\u003cp\u003eOf the 95 patients analyzed, 34 (35.8%) experienced recurrence, including 16 cases of local recurrence at the primary site, 15 cases of cervical lymph node metastases, and five cases of distant metastases (including overlapping recurrences). The median follow-up period for surviving patients was 68.8 months (range 0\u0026ndash;92.8). At the five-year follow-up, 74 patients were alive, 15 had died, and six were lost to follow-up. The five-year overall survival (5y-OS) rate was 85.1%, and the five-year recurrence-free survival (5y-RFS) rate was 62.7% (Fig. 3).\u003c/p\u003e\n\u003cp\u003eUnivariate analyses based on patient characteristics and treatment modalities are presented in Tables 5 and 6. Patients younger than 60 years had significantly better 5y-OS than those aged 60 or older (5y-OS of 95.3% vs. 75.5%, respectively; p = 0.015). Female patients had significantly better survival than male patients (5y-OS of 94.7% vs. 77.5%, respectively; p = 0.011). Although patients with advanced disease (T4, N1/2/3, or Stage IV) had worse 5y-OS and 5y-RFS outcomes, these differences were not statistically significant.\u003c/p\u003e\n\u003cp\u003eRegarding primary treatment (Table.6 and Fig. 4), the surgery-based group had a significantly higher 5y-RFS than the radiation-based group (5y-RFS of 69.4% vs. 48.9%, respectively; p = 0.010). Within the surgery-based group, patients who underwent surgery combined with radiotherapy had significantly better 5y-RFS than those who underwent surgery alone (5y-RFS of 79.6% vs. 40.8%, respectively; p = 0.030) (Fig. 5). Although patients who underwent surgery with systemic chemotherapy had higher 5y-OS and 5y-RFS than those who did not receive chemotherapy, this difference did not reach statistical significance.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provided a comprehensive analysis of the characteristics of patients with ONB in Japan through a large-scale, multicenter observational study. Similar to findings in other countries, ONB was slightly more common in males, with peak incidence occurring in patients in their 50s and 60s [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The primary site of ONB is typically the olfactory cleft or upper nasal cavity, but ectopic occurrences have also been reported. In a systematic review spanning 1955 to 2021, Lui et al. found that the ethmoid sinus accounted for 25% of cases, the maxillary sinus for 25%, and the sphenoid sinus for 16% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The distribution of cases in this study was consistent with previous reports.\u003c/p\u003e \u003cp\u003eThis study demonstrated that ONB was frequently diagnosed at an advanced stage (T4). Among all cases analyzed, 34.1% were classified as T4. When excluding the 140 cases with an unknown T classification, the proportion increased to 57.3%, indicating a high frequency of advanced-stage disease. This finding aligns with previous large case series, which have reported that approximately half of ONB cases fall into Kadish C or Dulguerov staging T4 categories [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Additionally, when comparing the early and late registration periods, the proportion of early-stage ONB increased in the later period. This tend suggests the possibility of earlier tumor detection, potentially due to the increasing use of flexible fiberoptic endoscopy and improved access to imaging studies in Japan.\u003c/p\u003e \u003cp\u003eThis study's 5y-OS and 5y-RFS rates were 85.1% and 62.7%, respectively, which were generally consistent with previous reports. The prognosis of ONB varies across studies, with 5y-OS rates ranging from 63\u0026ndash;89%. However, ONB is considered to have a relatively favorable prognosis among sinonasal malignancies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Despite this, long-term recurrence and metastasis remain significant clinical concerns. A single-center long-term follow-up study reported that the OS rate declined from 85.6% at 5 years to 62.7% at 10 years, while the RFS rate decreased from 65.8% at 5 years to 50% at 10 years [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Similarly, another study reported a 5y-OS of 83.4% and a 10-year OS of 76.1%, with disease-free survival rates of 80% at 5 years and 62.8% at 10 years [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. While the short-term prognosis for ONB is favorable, recurrence and subsequent mortality increase over time. Therefore, improving the prognosis of ONB, requires not only strengthening current primary treatment approaches but also developing effective preoperative and postoperative adjuvant therapies.\u003c/p\u003e \u003cp\u003eSeveral prognostic factors for ONB have been previously reported, particularly in cancer registry data from the United States. These studies have identified age, gender, Kadish staging, Hyams classification, lymph node metastasis, and resection margins as key prognostic indicators [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In this study, the 5y-OS rate was significantly better for patients younger than 60 years and for female patients, while the 5y-RFS rate was significantly higher for those who underwent surgery followed by postoperative radiotherapy. The relationship between age and ONB prognosis remains unclear. While some studies, consistent with our findings have reported poorer outcomes in elderly patients [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], others suggest that ONB may be more aggressive in younger individuals [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Naturally, older patients are more likely to have comorbidities and reduced physiological reserves, which may limit their ability to tolerate invasive treatments.\u003c/p\u003e \u003cp\u003eSimilarly, the influence of gender, on ONB prognosis remains inconclusive. Some studies have reported worse outcomes in male patients [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], while others suggest that male sex may be associated with poorer prognosis due to more advanced disease at presentation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, these differences may be influenced by other factors, such as tumor stage and histological grade. Further research is needed to clarify the role of gender in ONB prognosis.\u003c/p\u003e \u003cp\u003eFor the treatment of ONB, it is generally accepted that combining surgery with postoperative radiotherapy improves local control and prolongs survival [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, some reports have demonstrated improved local control without a corresponding survival benefit or have suggested that postoperative irradiation should be reserved only for locally advanced cases [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In the present study, postoperative irradiation improved 5y-RFS but did not significantly influence 5y-OS. This may be due to the relatively short observation period for ONB and missing data in this study. Additionally, this study did not identify T classification, lymph node metastasis, or stage classification as significant prognostic factors. The registry used in this study conducts prognostic follow-ups at the 5-year mark, but does not track outcomes beyond that point, limiting the evaluation of prognostic factors as well as long-term recurrence and metastasis in ONB.\u003c/p\u003e \u003cp\u003eIn earlier practice, tumor excision predominantly involved an open cranial base approach via a frontal craniotomy. However, with the introduction of endoscopic surgery over the past two decades, transnasal endoscopic skull base surgery has become the standard of care for ONB, due to its superior safety profile and favorable outcomes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The study period coincided with this shift in ONB treatment in Japan, transitioning from an era when open cranial base surgery was commonly performed to a period which endoscopic surgery became the standard approach. To evaluate this shift, we divided the study period into early and late phases, demonstrating a higher frequency of endoscopic surgery in the later period. Additionally, the proportion of surgical interventions increased among patients who underwent curative treatment, while the frequency of definitive radiotherapy decreased. This suggests that as endoscopic surgery became more widely adopted in Japan, surgical therapy for ONB was performed more actively. Although endoscopic surgery has reduced surgical invasiveness, some reports have indicated that it has not improved prognosis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, to achieve better outcomes for ONB, developing more effective preoperative and postoperative treatment strategies is essential.\u003c/p\u003e \u003cp\u003eStrengthening perioperative treatment is a potential option for improving ONB prognosis. Although not statistically significant, the data in this study suggested that patients who received chemotherapy had relatively better survival rates. Many of these patients underwent more extensive surgical procedures, indicating that chemotherapy was more commonly administered in advanced cases. The role of chemotherapy in ONB remains unclear [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]; however, some studies suggest that systemic chemotherapy may benefit locally advanced or unresectable cases [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. While certain reports suggest that adding chemotherapy to radiotherapy improves prognosis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], systematic reviews have refuted this claim [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Clinical trials are necessary to evaluate the efficacy of chemotherapeutic agents, including molecularly targeted therapies [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] and immune checkpoint inhibitors [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Given that ONB is a rare tumor, demonstrating the effectiveness of such treatments will likely require basket trials and other approaches for drug development in rare cancers.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, ONB is a rare cancer, making it difficult to accumulate a sufficient number of cases, even in multicenter collaborative studies. While this study analyzed a relatively large dataset of 346 cases, prognosis was assessed only at 5-year intervals, limiting the ability to conduct long-term follow-ups. Given the nature of ONB, this may be insufficient for a comprehensive analysis. Second, the registry used in this study was designed for all types of head and neck cancers and lacks ONB-specific data fields. As a result, widely used classification systems such as Kadish staging and Hyams grading could not be applied. Additionally, the surgical classification in the registry reflects the era of open skull base surgery in which it was established, potentially leading to inaccuracies in distinguishing between open cranial base surgery and endoscopic surgery. In particular, combined endoscopic surgery with open craniotomy was not assumed and may have been classified as open skull base surgery in this study.\u003c/p\u003e \u003cp\u003eAnother significant limitation is the lack of data on surgical margins, a critical prognostic factor, which further restricts the ability to assess prognosis. Additionally, missing data raises concerns about the accuracy of treatment and survival outcomes. Lastly, as an observational study, this research can only indicate associations rather than determine the optimal treatment strategy. Prospective randomized trials are needed to establish prognostic factors and evaluate the efficacy of different treatment approaches for ONB.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the Cancer Registry Committee of the Japan Society for Head and Neck Cancer for granting permission to conduct this study. We also extend our deepest gratitude to Japan\u0026apos;s head and neck surgeons who contributed to the Head and Neck Cancer Registry of Japan. This work was supported by JSPS KAKENHI Grant Number 24K18554.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data generated in this study are available in the article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConflict of interest: None.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eJethanamest D, Morris LG, Sikora AG, Kutler DI (2007) Esthesioneuroblastoma: a population-based analysis of survival and prognostic factors. Arch Otolaryngol Head Neck Surg 133 (3):276-280. doi:10.1001/archotol.133.3.276\u003c/li\u003e\n \u003cli\u003eMeerwein CM, Nikolaou G, G HAB, Soyka MB, Holzmann D (2021) Surgery as single-modality treatment for early-stage olfactory neuroblastoma: An institutional experience, systematic review and meta-analysis. Am J Rhinol Allergy 35 (4):525-534. doi:10.1177/1945892420973163\u003c/li\u003e\n \u003cli\u003eChoby G, Geltzeiler M, Almeida JP, Champagne PO, Chan E, Ciporen J, Chaskes MB, Fernandez-Miranda J, Gardner P, Hwang P, et al (2023) Multicenter survival analysis and application of an olfactory neuroblastoma staging modification incorporating Hyams grade. JAMA Otolaryngol Head Neck surg 149 (9):837-844. doi:10.1001/jamaoto.2023.1939\u003c/li\u003e\n \u003cli\u003eVuong HG, Nguyen DD, El-Rassi E, Ngo TNM, Dunn IF (2022) Absence of survival improvement for patients with esthesioneuroblastoma over the past 2 decades: A population-based study. World Neurosurg 157:e245-e253. doi:10.1016/j.wneu.2021.09.139\u003c/li\u003e\n \u003cli\u003eKawakita D, Yoshimoto S, Nakamizo M, Kitayama M, Kirita T, Kodaira T, Tomioka T, Kamiyama R, Takahashi H, Nakayama H, Ohyama Y, Murakami Y, Nibu KI (2025) Head and neck cancer registry of Japan. Auris, nasus, larynx 52 (2):122-126. doi:10.1016/j.anl.2025.01.007\u003c/li\u003e\n \u003cli\u003eMorita A, Ebersold MJ, Olsen KD, Foote RL, Lewis JE, Quast LM (1993) Esthesioneuroblastoma: Prognosis and management. Neurosurgery 32 (5):706-714; discussion 714-715. doi:10.1227/00006123-199305000-00002\u003c/li\u003e\n \u003cli\u003eDulguerov P, Calcaterra T (1992) Esthesioneuroblastoma: The UCLA experience 1970-1990. Laryngoscope 102 (8):843-849. doi:10.1288/00005537-199208000-00001\u003c/li\u003e\n \u003cli\u003eYin Z, Wang Y, Wu Y, Zhang X, Wang F, Wang P, Tao Z, Yuan Z (2018) Age distribution and age-related outcomes of olfactory neuroblastoma: A population-based analysis. Cancer Manag Res 10:1359-1364. doi:10.2147/CMAR.S151945\u003c/li\u003e\n \u003cli\u003eAbdelmeguid AS (2018) Olfactory neuroblastoma. Curr Oncol Rep 20 (1):7. doi:10.1007/s11912-018-0661-6\u003c/li\u003e\n \u003cli\u003eTosoni A, Di Nunno V, Gatto L, Corradi G, Bartolini S, Ranieri L, Franceschi E (2023) Olfactory neuroblastoma: Diagnosis, management, and current treatment options. Front Oncol 13:1242453. doi:10.3389/fonc.2023.1242453\u003c/li\u003e\n \u003cli\u003eLui CG, Badash I, Tang L, Mark ME, Batra PS, Wrobel BB (2024) Ectopic olfactory neuroblastoma: Systematic review of a rare clinical entity among sinonasal tumors. J Neurol Surg B Skull Base 85 (2):109-118. doi:10.1055/a-1993-7790\u003c/li\u003e\n \u003cli\u003eAbdelmeguid AS, Bell D, Roberts D, Ferrarotto R, Phan J, Su SY, Kupferman M, Raza S, DeMonte F, Hanna E (2022) Long-term outcomes of olfactory neuroblastoma: MD Anderson Cancer Center experience and review of the literature. Laryngoscope 132 (2):290-297. doi:10.1002/lary.29732\u003c/li\u003e\n \u003cli\u003eCarey RM, Godovchik J, Workman AD, Kuan EC, Parasher AK, Chen J, Palmer JN, Adappa ND, Newman JG, Brant JA (2017) Patient, disease, and treatment factors associated with overall survival in esthesioneuroblastoma. Int Forum Allergy Rhinol 7 (12):1186-1194. doi:10.1002/alr.22027\u003c/li\u003e\n \u003cli\u003eRimmer J, Lund VJ, Beale T, Wei WI, Howard D (2014) Olfactory neuroblastoma: A 35-year experience and suggested follow-up protocol. The Laryngoscope 124 (7):1542-1549. doi:10.1002/lary.24562\u003c/li\u003e\n \u003cli\u003eDiaz EM, Jr., Johnigan RH, 3rd, Pero C, El-Naggar AK, Roberts DB, Barker JL, DeMonte F (2005) Olfactory neuroblastoma: The 22-year experience at one comprehensive cancer center. Head \u0026amp; neck 27 (2):138-149. doi:10.1002/hed.20127\u003c/li\u003e\n \u003cli\u003eBisogno G, Soloni P, Conte M, Podda M, Ferrari A, Garaventa A, Luksch R, Cecchetto G (2012) Esthesioneuroblastoma in pediatric and adolescent age. A report from the TREP project in cooperation with the Italian Neuroblastoma and Soft Tissue Sarcoma Committees. BMC Cancer 12:117. doi:10.1186/1471-2407-12-117\u003c/li\u003e\n \u003cli\u003eBurnham AJ, Burnham PA, Horwitz EM (2021) Survival associations between patient age and treatment modality in olfactory neuroblastoma: A retrospective population-based study. J Clin Med 10 (12). doi:10.3390/jcm10122685\u003c/li\u003e\n \u003cli\u003eStokes WA, Camilon PR, Banglawala SM, Nguyen SA, Harvey R, Vandergrift WA, Schlosser RJ (2015) Is sex an independent prognostic factor in esthesioneuroblastoma? Am J Rhinol Allergy 29 (5):369-372. doi:10.2500/ajra.2015.29.4204\u003c/li\u003e\n \u003cli\u003eDe Bonnecaze G, Lepage B, Rimmer J, Al Hawat A, Vairel B, Serrano E, Chaput B, Vergez S (2016) Long-term carcinologic results of advanced esthesioneuroblastoma: A systematic review. Eur Arch Otorhinolaryngol 273 (1):21-26. doi:10.1007/s00405-014-3320-z\u003c/li\u003e\n \u003cli\u003eMody MD, Saba NF (2020) Multimodal therapy for sinonasal malignancies: Updates and review of current treatment. Curr Treat Options Oncol 21 (1):4. doi:10.1007/s11864-019-0696-4\u003c/li\u003e\n \u003cli\u003eKonuthula N, Iloreta AM, Miles B, Rhome R, Ozbek U, Genden EM, Posner M, Misiukiewicz K, Govindaraj S, Shrivastava R, Gupta V, Bakst RL (2017) Prognostic significance of Kadish staging in esthesioneuroblastoma: An analysis of the National Cancer Database. Head \u0026amp; neck 39 (10):1962-1968. doi:10.1002/hed.24770\u003c/li\u003e\n \u003cli\u003eHarvey RJ, Nalavenkata S, Sacks R, Adappa ND, Palmer JN, Purkey MT, Schlosser RJ, Snyderman C, Wang EW, Woodworth BA, Smee R, Havas T, Gallagher R (2017) Survival outcomes for stage-matched endoscopic and open resection of olfactory neuroblastoma. Head Neck 39 (12):2425-2432. doi:10.1002/hed.24912\u003c/li\u003e\n \u003cli\u003eBarinsky GL, Azmy MC, Kilic S, Grube JG, Baredes S, Hsueh WD, Eloy JA (2021) Comparison of open and endoscopic approaches in the resection of esthesioneuroblastoma. Ann Otol Rhinol Laryngol 130 (2):136-141. doi:10.1177/0003489420939582\u003c/li\u003e\n \u003cli\u003eCranmer LD, Chau B, Rockhill JK, Ferreira M, Jr., Liao JJ (2020) Chemotherapy in esthesioneuroblastoma/olfactory neuroblastoma: An analysis of the surveillance epidemiology and end results (SEER) 1973-2015 database. Am J Clin Oncol 43 (3):203-209. doi:10.1097/coc.0000000000000649\u003c/li\u003e\n \u003cli\u003eKuan EC, Wang EW, Adappa ND, Beswick DM, London NR, Jr., Su SY, Wang MB, Abuzeid WM, Alexiev B, Alt JA, Antognoni P, Alonso-Basanta M, et al (2024) International consensus statement on allergy and rhinology: Sinonasal rumors. Int Forum Allergy Rhinol 14 (2):149-608. doi:10.1002/alr.23262\u003c/li\u003e\n \u003cli\u003eMarinelli JP, Janus JR, Van Gompel JJ, Link MJ, Foote RL, Lohse CM, Price KA, Chintakuntlawar AV (2018) Esthesioneuroblastoma with distant metastases: Systematic review and meta-analysis. Head Neck 40 (10):2295-2303. doi:10.1002/hed.25209\u003c/li\u003e\n \u003cli\u003eOrton A, Boothe D, Evans D, Lloyd S, Monroe MM, Jensen R, Shrieve DC, Hitchcock YJ (2018) Esthesioneuroblastoma: A patterns-of-care and outcomes analysis of the National Cancer Database. Neurosurgery 83 (5):940-947. doi:10.1093/neuros/nyx535\u003c/li\u003e\n \u003cli\u003eSun M, Wang K, Qu Y, Zhang J, Zhang S, Chen X, Wang J, Wu R, Zhang Y, Yi J, Xiao J, Xu G, Huang X, Luo J (2020) Long-term analysis of multimodality treatment outcomes and prognosis of esthesioneuroblastomas: A single center results of 138 patients. Radiat Oncol 15 (1):219. doi:10.1186/s13014-020-01667-4\u003c/li\u003e\n \u003cli\u003ePreusser M, Hutterer M, Sohm M, Koperek O, Elandt K, Dieckmann K, Prayer D, Marosi C (2010) Disease stabilization of progressive olfactory neuroblastoma (esthesioneuroblastoma) under treatment with sunitinib mesylate. J Neurooncol 97 (2):305-308. doi:10.1007/s11060-009-0027-x\u003c/li\u003e\n \u003cli\u003eGay LM, Kim S, Fedorchak K, Kundranda M, Odia Y, Nangia C, Battiste J, Colon-Otero G, Powell S, Russell J, Elvin JA, Vergilio JA, Suh J, Ali SM, Stephens PJ, Miller VA, Ross JS (2017) Comprehensive genomic profiling of esthesioneuroblastoma reveals additional treatment options. Oncologist 22 (7):834-842. doi:10.1634/theoncologist.2016-0287\u003c/li\u003e\n \u003cli\u003eHoshi Y, Enokida T, Tamura S, Nakashima T, Okano S, Fujisawa T, Sato M, Wada A, Tanaka H, Takeshita N, Tanaka N, Onaga R, Kishida T, Uryu H, Sakashita S, Asakage T, Tahara M (2024) Efficacy of anti-PD-1 monotherapy for recurrent or metastatic olfactory neuroblastoma. Front Oncol 14:1379013. doi:10.3389/fonc.2024.1379013\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Patient characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAll (346)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEarly period (117)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eLate period (229)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Median (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e55 (0-88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e59 (20-88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e54 (0-88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e60.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e55.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e62.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e39.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e37.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003ePerformance Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e71.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e62.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e75.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e17.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e28.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Disease characteristics\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eAll (346)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eEarly period (117)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eLate period (229)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003ePrimary site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Nasal cavity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e60.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Maxillary sinus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Ethmoid sinus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Sphenoid sinus \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Posterior nostril /\u0026nbsp;\u003c/p\u003e\n \u003cp\u003enasal septum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Others and NOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eT classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 4（4, 4a, 4b）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e35.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e33.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No definition / unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e40.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e43.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eN classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e61.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e59.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e62.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No definition / unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e34.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eM classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e70.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e72.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No definition / unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Treatment characteristics\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eAll (346)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eEarly period (117)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eLate period (229)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eTreatment policy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; Radical treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e87.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e86.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; Palliative care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; Unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 327px;\"\u003e\n \u003cp\u003eTreatment sequence（of radical treatment）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; Surgery alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; Surgery + RT/CRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e53.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e45.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e57.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; Surgery + RT + Chemo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; Surgery + Chemo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; Radiation alone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; Radiation and Chemo (CRT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; RT/CRT + Chemo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; Chemo alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp; Unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSurgical Procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEndoscopic skull base surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e44.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e62.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eOpen skull base surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMaxillectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eOther and Unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e57.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eRT; radiotherapy, CRT; chemoradiotherapy, Chemo; chemotherapy.\u003c/p\u003e\n\u003cp\u003eTreatment sequence in no particular order\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4. Patient characteristics of 95 cases for prognostic analysis\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Median (range)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e60 (20-88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Male / Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e54 / 41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e56.8 / 43.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eT classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1 / 2 / 3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e2 / 14 / 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e2.1 / 14.7 / 7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 4（4, 4a, 4b）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No definition / unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eN classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e66.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1 / 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e1 / 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e1.1 / 5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No definition / unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eTreatment sequence（of radical treatment）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Surgery alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Surgery + RT/CRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Surgery + RT + Chemo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Surgery + Chemo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Radiation alone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; CRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; RT/CRT + Chemo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Chemo alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eRT; radiotherapy, CRT; chemoradiotherapy, Chemo; chemotherapy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5. Univariate analysis by patient characteristics of 95 cases for prognostic analysis \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e5y-OS (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5y-RFS (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eAll patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e85.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e62.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e \u0026nbsp; \u0026nbsp; \u0026lt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e95.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e65.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0.936\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e75.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e59.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e94.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e60.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e \u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e77.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e65.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eT classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eT1/2/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e86.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e69.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e85.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e47.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eN classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e85.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e57.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eN1/2/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eStage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003eStage I / II / III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e68.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e \u0026nbsp; \u0026nbsp; Stage IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e82.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e47.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e5y-OS; 5-year overall survival, 5y-RFS; 5-year recurrence free survival.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 6. Univariate analysis by primary treatment of 95 cases for prognostic analysis\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5y-OS (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e5y-RFS (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eMain treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e \u0026nbsp; \u0026nbsp; \u0026nbsp;Surgery-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e89.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e69.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e \u0026nbsp;Radiation-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e77.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e48.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003ePost-operative adjuvant therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e \u0026nbsp; \u0026nbsp; \u0026nbsp;with RT/CRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e92.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e79.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e \u0026nbsp; \u0026nbsp; \u0026nbsp;without RT/CRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e40.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003eAddition of chemotherapy \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e \u0026nbsp;with chemo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e80.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e \u0026nbsp;without chemo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e87.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e67.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e5y-OS; 5-year overall survival, 5y-RFS; 5-year recurrence free survival, RT; radiotherapy, CRT; chemoradiotherapy, Chemo; chemotherapy\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Olfactory neuroblastoma, prognosis, skull base surgery","lastPublishedDoi":"10.21203/rs.3.rs-6323600/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6323600/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Olfactory neuroblastoma (ONB) is a rare and malignant tumor of the nasal cavity. This study aimed to analyze cases of ONB from the Head and Neck Cancer Registry of Japan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: We identified 346 patients with ONB from 90,885 head and neck cancer registrations between 2011 and 2019. Data on demographics, TNM stage, and treatment modalities (surgery, radiotherapy, and chemotherapy) were collected. Patients were divided into early (2011–2015) and late (2016–2019) groups to assess changes in treatment patterns. Survival was analyzed in 95 patients with available follow-up data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: T4 lesions were frequently observed, and 234 patients (67.6%) underwent surgery-based treatment, typically combined with radiotherapy. Over time, the use of endoscopic approaches increased significantly, replacing open cranial base surgery. Among the 95 patients with evaluable follow-up data, the 5-year overall survival (OS) rate was 85.1%, while the recurrence-free survival (RFS) rate was 62.7%. Patients younger than 60 years and female patients had improved OS. Postoperative radiotherapy improved RFS but did not impact OS. Chemotherapy was frequently used in cases requiring extensive cranial base resections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: This large-scale, multicenter study provides insight into ONB treatment trends and outcomes in Japan. Although the 5-year prognosis is favorable, a significant risk of recurrence remains, emphasizing the need for optimized long-term treatment strategies. The widespread adoption of endoscopic surgery suggests shift toward less invasive approaches. Further prospective studies are needed to refine therapeutic options and improve long-term outcomes for patients with ONB.\u003c/p\u003e","manuscriptTitle":"Nationwide Analysis of Olfactory Neuroblastoma in Japan: Evolving Treatment Approaches and Prognostic Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 05:42:55","doi":"10.21203/rs.3.rs-6323600/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c9e6fb43-749a-40b2-894b-c7e6091f01ec","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T12:54:02+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-07 05:42:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6323600","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6323600","identity":"rs-6323600","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}