Toward vestibule-specific staging in nasal vestibule squamous cell carcinoma: a single-centre cohort study

Purpose Nasal vestibule squamous cell carcinoma (NV-SCC) lacks a universally accepted, site-specific staging system, limiting comparability across series and potentially influencing treatment selection. We evaluated variation in stage assignment and prognostic performance across four currently used classification systems in a single-centre cohort. Methods Patients with previously untreated NV-SCC managed between 2000 and 2024 were retrospectively reviewed. Tumours were restaged according to the UICC/AJCC sinonasal classification, the UICC/AJCC non-melanoma skin cancer classification, Wang’s classification, and the Rome classification. Overall survival (OS), disease-free survival (DFS), and local control (LC) were estimated using Kaplan-Meier analysis. Cox regression models explored associations between clinicopathological variables, treatment modality and outcomes. Results Seventy-eight patients were analysed. Restaging showed substantial discordance in stage assignment across systems. UICC-sinonasal staging assigned a considerable proportion of patients to locally advanced categories, whereas Wang’s classification concentrated most cases in cT2. The Rome classification appeared to provide a clinically coherent redistribution of early and advanced disease, although overlap between adjacent stages persisted. Bone infiltration showed the most consistent adverse association with OS, DFS, and LC across several staging-based models. Treatment-related associations were observed in selected models but should be considered exploratory because of the retrospective design and non-randomised treatment selection. Conclusion Applying different staging systems to NV-SCC showed considerable discordance in stage assignment and limited discrimination between adjacent categories. Vestibule-specific staging approaches, including the Rome classification, appeared anatomically coherent but require further validation. Bone infiltration was the most consistent adverse prognostic factor and should be considered in future refinements of staging systems.