{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T06:04:26Z","timestamp":1776405866692,"version":"3.51.2"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003130","name":"Fonds Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["Walter Vandeputte Head and Neck Cancer Fund"],"award-info":[{"award-number":["Walter Vandeputte Head and Neck Cancer Fund"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Sinonasal intestinal-type adenocarcinoma (ITAC) is a rare disease entity. In contrast to most previous studies, this cohort study consists of a substantial number of uniformly treated patients undergoing endoscopic surgery and adjuvant radiotherapy and provides updated insights into survival outcomes and tumor and treatment-related prognostic factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We retrospectively analyzed the medical records of 200 patients primarily treated for ITAC between 1992 and 2022 in our tertiary referral center. Descriptive statistics were applied using Kaplan-Meier method. Cox models were used for univariable and multivariable data analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 5-year overall survival (OS), disease-specific survival (DSS), and local recurrence-free survival (LRFS) rates were 71.4%, 85.1%, and 55.2% respectively. At 10 years, the numbers decreased to 48.2%, 76.2%, and 32.2% respectively. Significant differences were found in OS and DSS between T-groups. Poorly differentiated tumors had decreased DSS compared to well-differentiated tumors (HR: 3.38 [95% CI: 1.20\u20139.51], p=.0209). Signet-cell differentiation was associated with the poorest survival among poorly differentiated tumors although not reaching significance. In 34.0% of patients, there was local recurrence, with half of the cases detected within the first two years of follow-up but over 10% of recurrence occurring after 10 years. Positive surgical margins (HR: 2.95 [95% CI: 1.29\u20136.74], p=.0106), local recurrence (HR: 12.28 [95% CI: 5.59\u201326.99], p&amp;lt;.0001), and distant metastasis (HR: 41.17 [95% CI: 21.58\u201378.55], p&amp;lt;.0001) negatively affected DSS. Distant metastasis occurred more frequently in poorly differentiated tumors (25.6%) compared to moderately differentiated (9.5%) and well-differentiated tumors (2.5%) (p=.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This extensive study focusing on sinonasal ITAC primarily managed through endoscopic resection and radiotherapy, demonstrates that T-classification and tumor differentiation are independent prognostic factors influencing survival. 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