Outcomes for Sinonasal Undifferentiated Carcinoma (SNUC): An International Multi-Center Retrospective Cohort Study

Jacklyn Liu; Yoko Takahashi; Umar Rehman; Mario Turri-Zanoni; Davide Mattavelli; Nicholas Counsell; Marco Ferrari; Vittorio Rampinelli; William Vermi; Davide Lombardi; Rami Saade; Ki Wan Park; Oscar Emanuel; Volker H. Schartinger; Alessandro Franchi; Carla Facco; Fausto Sessa; Simonetta Battocchio; Patrick Rene Gerhard Eriksen; Simone Kloch Bendtsen; Kathrine Kronberg Jakobsen; Mohamed el Haddouchi; Roberta Maragliano; Giedrius Lelkaitis; Anirudh Saraswathula; Raman Preet Kaur; Wojciech K. Mydlarz; Murugappan Ramanathan; Masaru Ishii; Manas Dave; Tim R. Fenton; Alison Lim; Saleh Okhovat; Gyleen Elegio; Charles Dupin; Pierre Pouvreau; Juliette Thariat; Laurence Digue; Francois Regis Ferrand; Valerie Costes-Martineau; Claire Castain; Héloïse De Kermadec; Justin Hintze; James Paul O’Neill; Peter Lacy; Francis M. Vaz; Paul O’Flynn; David J. Howard; Paul Stimpson; Simon Wang; Gary Royle; Christopher Steele; Amrita Jay; Dawn Carnell; Martin D. Forster; David Thomson; Christian von Buchwald; Robbie Woods; Jose Luis Lllorente; Mario Hermsen; Philipp Jurmeister; David Capper; Gary L. Gallia; Joshua K. Tay; Ahmed Mohyeldin; Juan Fernandez-Miranda; Quynh Thu Le; Robert B. West; Zara M. Patel; Jayakar V. Nayak; Peter H. Hwang; Fabio Facchetti; Piero Nicolai; Renata Ferrarotto; Jack Phan; Paolo Bossi; Paolo Castelnuovo; Antoine Moya-Plana; Benjamin Verillaud; Cathie Garnis; Andrew Thamboo; Felicia Olawuni; Eric J. Moore; Garret Choby; Devyani Lal; Neal Akhave; Diana Bell; Shirley Y. Su; Valerie J. Lund; Nyall R. London; Ehab Y. Hanna; Matt Lechner

doi:10.3390/cancers18030366

Outcomes for Sinonasal Undifferentiated Carcinoma (SNUC): An International Multi-Center Retrospective Cohort Study

Jacklyn Liu, Yoko Takahashi, Umar Rehman, Mario Turri-Zanoni, Davide Mattavelli, Nicholas Counsell, Marco Ferrari, Vittorio Rampinelli, William Vermi, Davide Lombardi, Rami Saade, Ki Wan Park, Oscar Emanuel, Volker H. Schartinger, Alessandro Franchi, Carla Facco, Fausto Sessa, Simonetta Battocchio, Patrick Rene Gerhard Eriksen, Simone Kloch BendtsenKathrine Kronberg Jakobsen, Mohamed el Haddouchi, Roberta Maragliano, Giedrius Lelkaitis, Anirudh Saraswathula, Raman Preet Kaur, Wojciech K. Mydlarz, Murugappan Ramanathan, Masaru Ishii, Manas Dave, Tim R. Fenton, Alison Lim, Saleh Okhovat, Gyleen Elegio, Charles Dupin, Pierre Pouvreau, Juliette Thariat, Laurence Digue, Francois Regis Ferrand, Valerie Costes-Martineau, Claire Castain, Héloïse De Kermadec, Justin Hintze, James Paul O’Neill, Peter Lacy, Francis M. Vaz, Paul O’Flynn, David J. Howard, Paul Stimpson, Simon Wang, Gary Royle, Christopher Steele, Amrita Jay, Dawn Carnell, Martin D. Forster, David Thomson, Christian von Buchwald, Robbie Woods, Jose Luis Lllorente, Mario Hermsen, Philipp Jurmeister, David Capper, Gary L. Gallia, Joshua K. Tay, Ahmed Mohyeldin, Juan Fernandez-Miranda, Quynh Thu Le, Robert B. West, Zara M. Patel, Jayakar V. Nayak, Peter H. Hwang, Fabio Facchetti, Piero Nicolai, Renata Ferrarotto, Jack Phan, Paolo Bossi, Paolo Castelnuovo, Antoine Moya-Plana, Benjamin Verillaud, Cathie Garnis, Andrew Thamboo, Felicia Olawuni, Eric J. Moore, Garret Choby, Devyani Lal, Neal Akhave, Diana Bell, Shirley Y. Su, Valerie J. Lund, Nyall R. London, Ehab Y. Hanna^*, Matt Lechner^*

^*Corresponding author af dette arbejde

Abstract

Background: Sinonasal undifferentiated carcinoma (SNUC) is an extremely rare, high-grade, and aggressive tumor of the sinonasal tract. Due to the rarity of this malignancy, current treatment guidelines are based on small and often/mainly single-center retrospective datasets. In the absence of a universally accepted standard of care for SNUC, treatment approaches vary across countries and institutions, reflecting real-world clinical practice. The primary aim of this study was to describe real-world treatment and outcomes for patients with confirmed SNUC. Methods: This was an international, multi-center, retrospective, observational cohort study that pooled patients into the largest SNUC dataset to date. Fifteen centers were enrolled to contribute data, including seven from Europe, four from the United States, three from the United Kingdom, and one from Canada. In the absence of a universally accepted standard of care for SNUC, treatment approaches varied across countries and institutions, reflecting real-world clinical practice. Patients included were those with histologically confirmed SNUC who were treated between 1997 and 2021. Results: This study yielded 485 patients treated for SNUC. The median age at diagnosis was 55.6 years (IQR: 44.5–67.6), and 63.7% were male. Most cases presented at advanced stages, with 70.8% as T4a or T4b. Overall survival (OS) outcomes were available for 412 patients, with a median follow-up of 26.0 months. The 5- and 10-year OS were 47.2% (95% CI: 40.8–53.3%) and 39.6% (95% CI: 32.5–46.6%), respectively. Advanced age, dichotomized T-stage (T4a/b vs. T1–3), M-stage, and orbital involvement were significant poor prognostic factors on univariable analysis (p’s < 0.01). On multivariable analysis, orbital involvement (HR: 2.73, 95% CI: 1.42–5.27, p = 0.003) and distance metastasis stage (HR: 3.00, 95% CI: 1.25–7.21, p = 0.014) were both independently associated with worse OS. Conclusions: This observational study presents the largest multi-center cohort analysis of SNUC to date, providing new insights into prognostic factors for a rare cancer treated at global centers of excellence. Orbital involvement and the presence of metastases are candidate independent risk factors associated with poorer OS.

Originalsprog	Engelsk
Artikelnummer	366
Tidsskrift	Cancers
Vol/bind	18
Udgave nummer	3
ISSN	2072-6694
DOI	https://doi.org/10.3390/cancers18030366
Status	Udgivet - feb. 2026

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10.3390/cancers18030366Licens: CC BY

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Liu, J., Takahashi, Y., Rehman, U., Turri-Zanoni, M., Mattavelli, D., Counsell, N., Ferrari, M., Rampinelli, V., Vermi, W., Lombardi, D., Saade, R., Park, K. W., Emanuel, O., Schartinger, V. H., Franchi, A., Facco, C., Sessa, F., Battocchio, S., Eriksen, P. R. G., ... Lechner, M. (2026). Outcomes for Sinonasal Undifferentiated Carcinoma (SNUC): An International Multi-Center Retrospective Cohort Study. Cancers, 18(3), Artikel 366. https://doi.org/10.3390/cancers18030366

Liu, J, Takahashi, Y, Rehman, U, Turri-Zanoni, M, Mattavelli, D, Counsell, N, Ferrari, M, Rampinelli, V, Vermi, W, Lombardi, D, Saade, R, Park, KW, Emanuel, O, Schartinger, VH, Franchi, A, Facco, C, Sessa, F, Battocchio, S, Eriksen, PRG , Bendtsen, SK , Kronberg Jakobsen, K, el Haddouchi, M, Maragliano, R, Lelkaitis, G, Saraswathula, A, Kaur, RP, Mydlarz, WK, Ramanathan, M, Ishii, M, Dave, M, Fenton, TR, Lim, A, Okhovat, S, Elegio, G, Dupin, C, Pouvreau, P, Thariat, J, Digue, L, Ferrand, FR, Costes-Martineau, V, Castain, C, De Kermadec, H, Hintze, J, O’Neill, JP, Lacy, P, Vaz, FM, O’Flynn, P, Howard, DJ, Stimpson, P, Wang, S, Royle, G, Steele, C, Jay, A, Carnell, D, Forster, MD, Thomson, D, von Buchwald, C, Woods, R, Lllorente, JL, Hermsen, M, Jurmeister, P, Capper, D, Gallia, GL, Tay, JK, Mohyeldin, A, Fernandez-Miranda, J, Le, QT, West, RB, Patel, ZM, Nayak, JV, Hwang, PH, Facchetti, F, Nicolai, P, Ferrarotto, R, Phan, J, Bossi, P, Castelnuovo, P, Moya-Plana, A, Verillaud, B, Garnis, C, Thamboo, A, Olawuni, F, Moore, EJ, Choby, G, Lal, D, Akhave, N, Bell, D, Su, SY, Lund, VJ, London, NR, Hanna, EY & Lechner, M 2026, 'Outcomes for Sinonasal Undifferentiated Carcinoma (SNUC): An International Multi-Center Retrospective Cohort Study', Cancers, bind 18, nr. 3, 366. https://doi.org/10.3390/cancers18030366

@article{0b4f8e42c01949d4a9d5efdb39809ea7,

title = "Outcomes for Sinonasal Undifferentiated Carcinoma (SNUC): An International Multi-Center Retrospective Cohort Study",

abstract = "Background: Sinonasal undifferentiated carcinoma (SNUC) is an extremely rare, high-grade, and aggressive tumor of the sinonasal tract. Due to the rarity of this malignancy, current treatment guidelines are based on small and often/mainly single-center retrospective datasets. In the absence of a universally accepted standard of care for SNUC, treatment approaches vary across countries and institutions, reflecting real-world clinical practice. The primary aim of this study was to describe real-world treatment and outcomes for patients with confirmed SNUC. Methods: This was an international, multi-center, retrospective, observational cohort study that pooled patients into the largest SNUC dataset to date. Fifteen centers were enrolled to contribute data, including seven from Europe, four from the United States, three from the United Kingdom, and one from Canada. In the absence of a universally accepted standard of care for SNUC, treatment approaches varied across countries and institutions, reflecting real-world clinical practice. Patients included were those with histologically confirmed SNUC who were treated between 1997 and 2021. Results: This study yielded 485 patients treated for SNUC. The median age at diagnosis was 55.6 years (IQR: 44.5–67.6), and 63.7\% were male. Most cases presented at advanced stages, with 70.8\% as T4a or T4b. Overall survival (OS) outcomes were available for 412 patients, with a median follow-up of 26.0 months. The 5- and 10-year OS were 47.2\% (95\% CI: 40.8–53.3\%) and 39.6\% (95\% CI: 32.5–46.6\%), respectively. Advanced age, dichotomized T-stage (T4a/b vs. T1–3), M-stage, and orbital involvement were significant poor prognostic factors on univariable analysis (p{\textquoteright}s < 0.01). On multivariable analysis, orbital involvement (HR: 2.73, 95\% CI: 1.42–5.27, p = 0.003) and distance metastasis stage (HR: 3.00, 95\% CI: 1.25–7.21, p = 0.014) were both independently associated with worse OS. Conclusions: This observational study presents the largest multi-center cohort analysis of SNUC to date, providing new insights into prognostic factors for a rare cancer treated at global centers of excellence. Orbital involvement and the presence of metastases are candidate independent risk factors associated with poorer OS.",

keywords = "sinonasal undifferentiated carcinoma, SNUC, survival outcomes",

author = "Jacklyn Liu and Yoko Takahashi and Umar Rehman and Mario Turri-Zanoni and Davide Mattavelli and Nicholas Counsell and Marco Ferrari and Vittorio Rampinelli and William Vermi and Davide Lombardi and Rami Saade and Park, \{Ki Wan\} and Oscar Emanuel and Schartinger, \{Volker H.\} and Alessandro Franchi and Carla Facco and Fausto Sessa and Simonetta Battocchio and Eriksen, \{Patrick Rene Gerhard\} and Bendtsen, \{Simone Kloch\} and \{Kronberg Jakobsen\}, Kathrine and \{el Haddouchi\}, Mohamed and Roberta Maragliano and Giedrius Lelkaitis and Anirudh Saraswathula and Kaur, \{Raman Preet\} and Mydlarz, \{Wojciech K.\} and Murugappan Ramanathan and Masaru Ishii and Manas Dave and Fenton, \{Tim R.\} and Alison Lim and Saleh Okhovat and Gyleen Elegio and Charles Dupin and Pierre Pouvreau and Juliette Thariat and Laurence Digue and Ferrand, \{Francois Regis\} and Valerie Costes-Martineau and Claire Castain and \{De Kermadec\}, H{\'e}lo{\"i}se and Justin Hintze and O{\textquoteright}Neill, \{James Paul\} and Peter Lacy and Vaz, \{Francis M.\} and Paul O{\textquoteright}Flynn and Howard, \{David J.\} and Paul Stimpson and Simon Wang and Gary Royle and Christopher Steele and Amrita Jay and Dawn Carnell and Forster, \{Martin D.\} and David Thomson and \{von Buchwald\}, Christian and Robbie Woods and Lllorente, \{Jose Luis\} and Mario Hermsen and Philipp Jurmeister and David Capper and Gallia, \{Gary L.\} and Tay, \{Joshua K.\} and Ahmed Mohyeldin and Juan Fernandez-Miranda and Le, \{Quynh Thu\} and West, \{Robert B.\} and Patel, \{Zara M.\} and Nayak, \{Jayakar V.\} and Hwang, \{Peter H.\} and Fabio Facchetti and Piero Nicolai and Renata Ferrarotto and Jack Phan and Paolo Bossi and Paolo Castelnuovo and Antoine Moya-Plana and Benjamin Verillaud and Cathie Garnis and Andrew Thamboo and Felicia Olawuni and Moore, \{Eric J.\} and Garret Choby and Devyani Lal and Neal Akhave and Diana Bell and Su, \{Shirley Y.\} and Lund, \{Valerie J.\} and London, \{Nyall R.\} and Hanna, \{Ehab Y.\} and Matt Lechner",

note = "Publisher Copyright: {\textcopyright} 2026 by the authors.",

year = "2026",

month = feb,

doi = "10.3390/cancers18030366",

language = "English",

volume = "18",

journal = "Cancers",

issn = "2072-6694",

publisher = "M D P I AG",

number = "3",

}

TY - JOUR

T1 - Outcomes for Sinonasal Undifferentiated Carcinoma (SNUC)

T2 - An International Multi-Center Retrospective Cohort Study

AU - Liu, Jacklyn

AU - Takahashi, Yoko

AU - Rehman, Umar

AU - Turri-Zanoni, Mario

AU - Mattavelli, Davide

AU - Counsell, Nicholas

AU - Ferrari, Marco

AU - Rampinelli, Vittorio

AU - Vermi, William

AU - Lombardi, Davide

AU - Saade, Rami

AU - Park, Ki Wan

AU - Emanuel, Oscar

AU - Schartinger, Volker H.

AU - Franchi, Alessandro

AU - Facco, Carla

AU - Sessa, Fausto

AU - Battocchio, Simonetta

AU - Eriksen, Patrick Rene Gerhard

AU - Bendtsen, Simone Kloch

AU - Kronberg Jakobsen, Kathrine

AU - el Haddouchi, Mohamed

AU - Maragliano, Roberta

AU - Lelkaitis, Giedrius

AU - Saraswathula, Anirudh

AU - Kaur, Raman Preet

AU - Mydlarz, Wojciech K.

AU - Ramanathan, Murugappan

AU - Ishii, Masaru

AU - Dave, Manas

AU - Fenton, Tim R.

AU - Lim, Alison

AU - Okhovat, Saleh

AU - Elegio, Gyleen

AU - Dupin, Charles

AU - Pouvreau, Pierre

AU - Thariat, Juliette

AU - Digue, Laurence

AU - Ferrand, Francois Regis

AU - Costes-Martineau, Valerie

AU - Castain, Claire

AU - De Kermadec, Héloïse

AU - Hintze, Justin

AU - O’Neill, James Paul

AU - Lacy, Peter

AU - Vaz, Francis M.

AU - O’Flynn, Paul

AU - Howard, David J.

AU - Stimpson, Paul

AU - Wang, Simon

AU - Royle, Gary

AU - Steele, Christopher

AU - Jay, Amrita

AU - Carnell, Dawn

AU - Forster, Martin D.

AU - Thomson, David

AU - von Buchwald, Christian

AU - Woods, Robbie

AU - Lllorente, Jose Luis

AU - Hermsen, Mario

AU - Jurmeister, Philipp

AU - Capper, David

AU - Gallia, Gary L.

AU - Tay, Joshua K.

AU - Mohyeldin, Ahmed

AU - Fernandez-Miranda, Juan

AU - Le, Quynh Thu

AU - West, Robert B.

AU - Patel, Zara M.

AU - Nayak, Jayakar V.

AU - Hwang, Peter H.

AU - Facchetti, Fabio

AU - Nicolai, Piero

AU - Ferrarotto, Renata

AU - Phan, Jack

AU - Bossi, Paolo

AU - Castelnuovo, Paolo

AU - Moya-Plana, Antoine

AU - Verillaud, Benjamin

AU - Garnis, Cathie

AU - Thamboo, Andrew

AU - Olawuni, Felicia

AU - Moore, Eric J.

AU - Choby, Garret

AU - Lal, Devyani

AU - Akhave, Neal

AU - Bell, Diana

AU - Su, Shirley Y.

AU - Lund, Valerie J.

AU - London, Nyall R.

AU - Hanna, Ehab Y.

AU - Lechner, Matt

PY - 2026/2

Y1 - 2026/2

N2 - Background: Sinonasal undifferentiated carcinoma (SNUC) is an extremely rare, high-grade, and aggressive tumor of the sinonasal tract. Due to the rarity of this malignancy, current treatment guidelines are based on small and often/mainly single-center retrospective datasets. In the absence of a universally accepted standard of care for SNUC, treatment approaches vary across countries and institutions, reflecting real-world clinical practice. The primary aim of this study was to describe real-world treatment and outcomes for patients with confirmed SNUC. Methods: This was an international, multi-center, retrospective, observational cohort study that pooled patients into the largest SNUC dataset to date. Fifteen centers were enrolled to contribute data, including seven from Europe, four from the United States, three from the United Kingdom, and one from Canada. In the absence of a universally accepted standard of care for SNUC, treatment approaches varied across countries and institutions, reflecting real-world clinical practice. Patients included were those with histologically confirmed SNUC who were treated between 1997 and 2021. Results: This study yielded 485 patients treated for SNUC. The median age at diagnosis was 55.6 years (IQR: 44.5–67.6), and 63.7% were male. Most cases presented at advanced stages, with 70.8% as T4a or T4b. Overall survival (OS) outcomes were available for 412 patients, with a median follow-up of 26.0 months. The 5- and 10-year OS were 47.2% (95% CI: 40.8–53.3%) and 39.6% (95% CI: 32.5–46.6%), respectively. Advanced age, dichotomized T-stage (T4a/b vs. T1–3), M-stage, and orbital involvement were significant poor prognostic factors on univariable analysis (p’s < 0.01). On multivariable analysis, orbital involvement (HR: 2.73, 95% CI: 1.42–5.27, p = 0.003) and distance metastasis stage (HR: 3.00, 95% CI: 1.25–7.21, p = 0.014) were both independently associated with worse OS. Conclusions: This observational study presents the largest multi-center cohort analysis of SNUC to date, providing new insights into prognostic factors for a rare cancer treated at global centers of excellence. Orbital involvement and the presence of metastases are candidate independent risk factors associated with poorer OS.

AB - Background: Sinonasal undifferentiated carcinoma (SNUC) is an extremely rare, high-grade, and aggressive tumor of the sinonasal tract. Due to the rarity of this malignancy, current treatment guidelines are based on small and often/mainly single-center retrospective datasets. In the absence of a universally accepted standard of care for SNUC, treatment approaches vary across countries and institutions, reflecting real-world clinical practice. The primary aim of this study was to describe real-world treatment and outcomes for patients with confirmed SNUC. Methods: This was an international, multi-center, retrospective, observational cohort study that pooled patients into the largest SNUC dataset to date. Fifteen centers were enrolled to contribute data, including seven from Europe, four from the United States, three from the United Kingdom, and one from Canada. In the absence of a universally accepted standard of care for SNUC, treatment approaches varied across countries and institutions, reflecting real-world clinical practice. Patients included were those with histologically confirmed SNUC who were treated between 1997 and 2021. Results: This study yielded 485 patients treated for SNUC. The median age at diagnosis was 55.6 years (IQR: 44.5–67.6), and 63.7% were male. Most cases presented at advanced stages, with 70.8% as T4a or T4b. Overall survival (OS) outcomes were available for 412 patients, with a median follow-up of 26.0 months. The 5- and 10-year OS were 47.2% (95% CI: 40.8–53.3%) and 39.6% (95% CI: 32.5–46.6%), respectively. Advanced age, dichotomized T-stage (T4a/b vs. T1–3), M-stage, and orbital involvement were significant poor prognostic factors on univariable analysis (p’s < 0.01). On multivariable analysis, orbital involvement (HR: 2.73, 95% CI: 1.42–5.27, p = 0.003) and distance metastasis stage (HR: 3.00, 95% CI: 1.25–7.21, p = 0.014) were both independently associated with worse OS. Conclusions: This observational study presents the largest multi-center cohort analysis of SNUC to date, providing new insights into prognostic factors for a rare cancer treated at global centers of excellence. Orbital involvement and the presence of metastases are candidate independent risk factors associated with poorer OS.

KW - sinonasal undifferentiated carcinoma

KW - SNUC

KW - survival outcomes

UR - https://www.scopus.com/pages/publications/105030036566

U2 - 10.3390/cancers18030366

DO - 10.3390/cancers18030366

M3 - Journal article

C2 - 41681839

AN - SCOPUS:105030036566

SN - 2072-6694

VL - 18

JO - Cancers

JF - Cancers

IS - 3

M1 - 366

ER -

Outcomes for Sinonasal Undifferentiated Carcinoma (SNUC): An International Multi-Center Retrospective Cohort Study

Abstract

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