Improvement in survival during the past 4 decades among patients with anterior skull base cancer

Background The aims of this study were to determine the trends in survival of patients with anterior skull base cancer over several decades and to identify time-related changes in the demographic and clinical characteristics of this population. Methods In all, 282 patients who underwent craniofacial resection at Memorial Sloan-Kettering Cancer Center and Tel Aviv Medical Center were studied. Patients were categorized in accord with the period of surgery: early (1973-1984, n = 34), intermediate (1985-1996, n = 72), and later (1997-2008, n = 176). Results Patients operated after 1996 had higher rates of comorbidity, dural and pterygopalatine invasion, and multicompartmental involvement than those operated before 1996 (p ≤.001). There was a significant improvement in 5-year overall and disease-specific survival, from 55% and 57%, respectively, for patients operated before 1996, to 66% and 70%, respectively, for those operated after 1996 (p =.02 and p =.006, respectively). On multivariate analysis, surgery after 1996 was an independent predictor of outcome (HR, 0.39, p <.001). Conclusions The survival of patients with anterior skull base cancer is improving. Surgery after 1996 is an independent prognostic factor for an improved outcome.