Nasopharyngeal Angiofibroma: Prognostic Factors for Recurrence and Proposal of a Staging System

Background: Nasopharyngeal angiofibroma (NA) is a rare vascular tumor of the nasopharynx. Our aim is to analyze prognostic factors and propose a staging system for NA. Materials and Methods: Retrospective study of patients with NA treated from 1981 to 2003. Clinical, radiological, and therapeutic data were assessed for recurrence- and disease-free survival-associated prognostic factors. Bivariate and multivariate analyses were performed. Results: Fifty-four males were analyzed. Age varied from 12 to 35 years (mean 18.5 years; standard deviation [SD], 4.9). Invasion to pterygomaxillary fossae, to infratemporal fossae, or to skull base and/or intracranial extension were associated with recurrences in 2 of 14, in 5 of 12, and in 11 of 18 cases, respectively. Tumors < or ≥ to 6 cm were associated with zero and 18 recurrences, respectively (p = .006). A staging system was constructed with extension patterns and tumor size. Multivariate analyses conferred significance (p = .002) to a model including this staging system and surgical margins. Conclusion: Our system efficiently stratifies risks of recurrence- and disease-free survival. Endoscopic approaches could be considered in patients with minor lateral extensions, while wide surgical approaches are indicated in invasive cases. Radiotherapy could be applied for extensive intracranial involvement.