Surgical margin assessment and prognostic impact in sinonasal cancers: a systematic review and meta-analysis

Objective. Surgery remains a cornerstone in treatment of sinonasal malignancies, but the prognostic role of margin status is controversial. This systematic review and meta-analysis evaluated the prognostic significance of surgical margins in sinonasal cancer and their impact on survival, alongside key challenges in its evaluation. Methods. A systematic search in PubMed, Scopus, and Web of Science identified 64 studies (34,120 patients). Results. The overall margin infiltration rate was 33.2%, varying widely across studies (4.5-88.2%) and histotypes, and was the highest in adenoid cystic carcinoma (ACC, 61.5%). Meta-analysis of 31 studies showed positive margins were associated with worse survival (overall survival, odds ratio [OR] 2.61; disease-specific survival, OR 5.89; disease-free survival, OR 4.40). Squamous cell carcinoma, olfactory neuroblastoma, and mucosal melanoma had the strongest correlation with margin status, while for ACC and adenocarcinomas statistical significance was not reached. High heterogeneity was noted across studies, alongside inconsistent margin classification, distance thresholds, and use of frozen sections, limiting cross-study comparability. Conclusions. This study confirms the prognostic value of surgical margins, but underscores the urgent need for standardised definitions to improve prediction of oncologic outcomes and clinical decision-making.