Development and validation of a clinico-histological factor-based nomogram for survival in sinonasal malignancies

Why this matters to patients and families

Cancers that arise deep in the nose and nearby sinuses are rare, but when they do occur they can be frightening and difficult to treat. Because doctors see relatively few of these tumors, it has been hard to give patients clear, personalized answers to basic questions: How long might I live? Which treatments seem most promising for someone like me? This study uses a large U.S. cancer database to build a practical prediction tool that helps doctors estimate survival for individual patients and to compare how different treatment choices are likely to play out.

A rare group of cancers with many faces

Sinonasal cancers grow in the nasal cavity and the air-filled spaces around it. Typical warning signs include blocked breathing through the nose, nosebleeds, or facial pain; in advanced cases, the tumor can press on the eyes or nerves. These cancers are uncommon—about half a case per 100,000 people each year—and come in several distinct tissue types, from squamous cell carcinoma and adenocarcinoma to rarer forms such as adenoid cystic carcinoma, undifferentiated carcinoma, mucosal melanoma, neuroendocrine tumors, and olfactory neuroblastoma. Each type behaves differently, and outcomes depend not only on tumor biology but also on where the cancer sits, how far it has spread, and which treatments are used.

Building a prediction tool from real-world data

To bring more clarity to prognosis, the researchers drew on the U.S. Surveillance, Epidemiology, and End Results (SEER) program, which tracks cancer cases from many regions. They identified 6,286 people diagnosed with sinonasal malignancies between 2010 and 2021; 5,795 of them had one of six main tissue types and complete enough information to be used to build a prediction model. For each patient, the team recorded age, sex, marital status, race, exact tumor location in the sinonasal region, overall cancer stage, tissue type, and whether the person had surgery, radiation, or chemotherapy. Because some details were missing, they used established statistical methods to fill in gaps in a way that preserves overall patterns, then tested which factors truly helped predict survival.

How the survival “scorecard” works

The final tool, called a nomogram, acts like a visual scorecard. For a given patient, the doctor assigns points based on age, sex, whether the patient is married, where the tumor sits (nasal cavity versus specific sinuses), how advanced the cancer is according to standard staging rules, the tissue type, and whether surgery and radiation are planned. Adding these points gives a total score, which then maps to estimated chances of being alive one, three, and five years after diagnosis. When the authors checked the tool against actual outcomes, it discriminated well between people who did better and worse, with accuracy notably higher than chance and comparable to or better than earlier, narrower models built for single tumor types. Calibration checks showed that predicted and observed survival lined up closely, especially for one-year outcomes, and a decision analysis suggested that using the tool could guide treatment choices more effectively than relying on stage alone.

What the study says about treatment choices

Beyond prediction, the team also asked how different treatments were linked to survival within seven key tissue types. They used standard survival curves to compare strategies such as surgery alone, surgery plus radiation, radiation plus chemotherapy, or all three combined. In common squamous cell tumors, early-stage patients did similarly whether or not they received radiation in addition to surgery, while for more advanced but still localized disease, surgery plus radiation often outperformed adding chemotherapy. For some rare types, patterns differed: for adenocarcinoma, surgery alone tended to look better than adding radiation, whereas for mucosal melanoma and olfactory neuroblastoma, surgery combined with radiation was associated with longer survival than regimens that also included chemotherapy.

What this means for people facing these cancers

For patients and families confronting sinonasal cancer, this work does not offer a simple yes-or-no answer, but it does provide a clearer map. The nomogram allows clinicians to plug in a person’s basic characteristics and planned treatment to obtain individualized survival estimates, which can support frank, informed conversations about goals of care and potential benefits of aggressive therapy. At the same time, the survival comparisons across tumor types highlight where surgery and radiation appear most helpful, and where the added burden of chemotherapy may or may not pay off. While the tool cannot replace expert judgment—and does not yet cover some very rare subtypes—it marks an important step toward more transparent, data-driven guidance for a group of cancers that has long lacked it.

Citation: Zhong, CY., She, C. & Wang, SS. Development and validation of a clinico-histological factor-based nomogram for survival in sinonasal malignancies. Sci Rep 16, 11071 (2026). https://doi.org/10.1038/s41598-026-41278-9

Keywords: sinonasal cancer, survival prediction, nomogram, head and neck tumors, treatment outcomes