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Li W, Tucker B, Hu ZD, Zhang YJ, Guo XX, Cai WJ, Zhang MF, Han YT. Squamous cell carcinoma of ear and temporal bone: A retrospective study on clinicopathological predictors. Head Neck 2024. [PMID: 38867407 DOI: 10.1002/hed.27818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 04/01/2024] [Accepted: 05/07/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Ear and temporal bone squamous cell carcinoma (ETBSCC) is a rare and aggressive malignant tumor with minimal clinicopathological studies. The object of this study was to retrospectively evaluate the predictive effect of clinicopathological variables on the 5-year overall survival (OS) rate of ETBSCC patients in a single tertiary medical center in Tianjin, China. METHODS A cohort of 44 patients with diagnosed ETBSCC from December 2012 to August 2022 were retrospectively studied. Univariate and multivariate analysis were, respectively, performed for the assessment of clinicopathological predictors, including sex, age, history of chronic suppurative otitis media (CSOM), lesion side, diameter, the choice of surgical approach, parotidectomy, neck dissection, adjuvant therapies, T stage, lymph node metastasis, tumor grade, margin, perineural invasion (PNI), and Ki-67 index. RESULTS Seventeen females and 27 males were included, with the mean age of 65 years old, ranging from 36 to 89 years. The 5-year OS rate was 43% (mean 51 months, 95% confidence interval [CI] = 39-64). Significant prediction of a worse prognosis for 5-year OS rate was observed under univariate analysis for advanced T stage, positive margin, identified PNI, and higher Ki-67 index, respectively. Advanced T stage was confirmed to be an independent prognostic factor strongly affecting 5-year OS rate among this cohort of patients using a multivariate cox proportional hazard model. CONCLUSION We found that clinicopathological parameters, especially postoperative pathological parameters, play a critical role in predicting the prognosis of ETBSCC patients.
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Affiliation(s)
- Wei Li
- Department of Pathology, Tianjin First Central Hospital, The First Central Hospital Affiliated of Nankai University, Tianjin, China
| | - Bronwyn Tucker
- School of Medical English and Health Communication, Tianjin Medical University, Tianjin, China
| | - Zhan-Dong Hu
- Department of Pathology, Tianjin First Central Hospital, The First Central Hospital Affiliated of Nankai University, Tianjin, China
| | - Yu-Jie Zhang
- Department of Pathology, Tianjin First Central Hospital, The First Central Hospital Affiliated of Nankai University, Tianjin, China
| | - Xue-Xi Guo
- Department of Pathology, Tianjin First Central Hospital, The First Central Hospital Affiliated of Nankai University, Tianjin, China
| | - Wen-Juan Cai
- Department of Pathology, Tianjin First Central Hospital, The First Central Hospital Affiliated of Nankai University, Tianjin, China
| | - Ming-Fang Zhang
- Department of Pathology, Tianjin First Central Hospital, The First Central Hospital Affiliated of Nankai University, Tianjin, China
| | - Ya-Ting Han
- Department of Cell Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
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Brenet E, Atallah S, Guerlain J, Moya-Plana A, Verillaud B, Kania R, Bakhos D, Philouze P, Righini CA, Bozorg A, Mérol JC, Labrousse M, Vergez S, Fakhry N, Gallet P, Cullié D, Malard O, Mauvais O, Fath L, Schultz P, Dufour X, Saroul N, Evrard D, Lesnik M, Even C, Costes V, Thariat J, Taillandier de Gabory LL, Makeieff M, Dubernard X, Baujat B. Carcinomas of the external auditory canal: Management and results: A multicenter REFCOR propensity score matching study. Eur J Cancer 2024; 201:113922. [PMID: 38364629 DOI: 10.1016/j.ejca.2024.113922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To analyse prognostic factors and survival outcomes of malignant tumors of the external auditory canal, to investigate the role of regional surgery, and adjuvant radiotherapy in early stages and to investigate the role of surgery in operable T4 stage. SETTING A retrospective analysis was conducted on all patients prospectively included in the national database of the French Expertize Network for Rare ENT Cancers (REFCOR) from January 2000 to December 2016. PARTICIPANTS 103 patients from 19 reference centers were included. A propensity score matching analysis was applied to enable comparisons between treatments. MAIN OUTCOMES AND MEASURES Event-free survival, overall survival and factors of poor prognosis of the cohort were described. The interest of local and regional surgery and postoperative radiotherapy were evaluated. RESULTS The factors of poor prognosis on event-free survival were immunosuppression (p = 0.002), Karnofsky status less than 90% (p = 0.02), body mass index less than 19 Kg / m2 (p = 0.0009), peripheric facial palsy (p = 0.0016), and positive margin (p = 0.0006). In early stages, locoregional surgery was associated with an increase in event-free survival (p = 0.003, HR = 0.21) versus local surgery alone, while postoperative radiotherapy was not associated with an increase in event-free survival (p = 0.86, HR = 0.91) or overall (p = 0.86, HR = 0.91). In locally advanced stages, locoregional surgery followed by radiotherapy was associated with an increase in event-free survival (p = 0.03, HR = 0.39) and overall (p = 0.02, HR = 0.34) versus chemoradiotherapy alone. CONCLUSION AND RELEVANCE Regional surgery is recommended for early stages of cancers of the external auditory canal. In operable cases, locoregional surgery followed by radiotherapy is recommended.
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Affiliation(s)
- Esteban Brenet
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Sarah Atallah
- Department of ENT-Head and Neck Surgery, Tenon University Hospital, APHP, Sorbonne Universite, 75020 Paris, France; Doctoral School of Public Health, CESP, University of Paris Sud, 94807 Villejuif, France
| | - Joanne Guerlain
- Department of ENT-Head and Neck Surgery, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Antoine Moya-Plana
- Department of ENT-Head and Neck Surgery, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Benjamin Verillaud
- Department of ENT-Head and Neck Surgery, Lariboisière University Hospital, APHP, 75010 Paris, France
| | - Romain Kania
- Department of ENT-Head and Neck Surgery, Lariboisière University Hospital, APHP, 75010 Paris, France
| | - David Bakhos
- Department of ENT-Head and Neck Surgery, Bretonneau University Hospital, 37000 Tours, France
| | - Pierre Philouze
- Department of ENT-Head and Neck Surgery, La Croix Rousse University Hospital, HCL, 6900 Lyon, France
| | - Christian-Adrien Righini
- Department of ENT-Head and Neck Surgery, Grenoble Alpes University Hospital, 38043 Grenoble, France
| | - Alexis Bozorg
- Department of ENT-Head and Neck Surgery, François Mitterrand University Hospital, 21000 Dijon, France
| | - Jean-Claude Mérol
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Marc Labrousse
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Sébastien Vergez
- Department of ENT-Head and Neck Surgery, University Cancer Institute, 31100 Toulouse, France
| | - Nicolas Fakhry
- Department of ENT-Head and Neck Surgery, University Hospital of Marseille, APHM, 13915 Marseille, France
| | - Patrice Gallet
- Department of ENT-Head and Neck Surgery, University Hospital of Nancy, 54000 Nancy, France
| | - Dorian Cullié
- Department of ENT-Head and Neck Surgery, Lacassagne Cancer Institute, 06100 Nice, France
| | - Olivier Malard
- Department of ENT-Head and Neck Surgery, University Hospital of Nantes, 44093 Nantes, France
| | - Olivier Mauvais
- Department of ENT-Head and Neck Surgery, University Hospital of Besançon, 25000 Besançon, France
| | - Léa Fath
- Department of ENT-Head and Neck Surgery, University Hospital of Hautepierre, HUS, 67200 Strasbourg, France
| | - Philippe Schultz
- Department of ENT-Head and Neck Surgery, University Hospital of Hautepierre, HUS, 67200 Strasbourg, France
| | - Xavier Dufour
- Department of ENT-Head and Neck Surgery, University Hospital of Poitiers, 86021 Poitiers, France
| | - Nicolas Saroul
- Department of ENT-Head and Neck Surgery, University Hospital of Clermont-Ferrand, 63000, France
| | - Diane Evrard
- Department of ENT-Head and Neck Surgery, Bichat University Hospital, APHP, 75018 Paris, France
| | - Maria Lesnik
- Department of ENT-Head and Neck Surgery, Curie Cancer Institute, APHP, 75005 Paris, France
| | - Caroline Even
- Department of Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Valérie Costes
- Department of Pathologic Anatomy and onco-biology, University Hospital of Montpellier, France
| | - Juliette Thariat
- Department of Radiation Oncology, Cancer center Baclesse, 14076 Caen, France
| | | | - Marc Makeieff
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Xavier Dubernard
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Bertrand Baujat
- Department of ENT-Head and Neck Surgery, Tenon University Hospital, APHP, Sorbonne Universite, 75020 Paris, France.
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Gowrishankar S, Borsetto D, Marinelli J, Panizza B. Temporal bone management in external and middle ear carcinoma. Curr Opin Otolaryngol Head Neck Surg 2024; 32:138-142. [PMID: 38193562 DOI: 10.1097/moo.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to outline the temporal bone management of external and middle ear carcinoma. The review will outline the current evidence involved in deciding which surgical approach to take, as well as new advances in auditory rehabilitation and immunotherapy. RECENT FINDINGS Traditional surgical approaches include lateral temporal bone resection, subtotal temporal bone resection and total temporal bone resection. They can also involve parotidectomy and neck dissection depending on extension of disease into these areas. Options for auditory rehabilitation include osseointegrated hearing aids, transcutaneous bone-conduction implants, and active middle ear implants. Recent advances in immunotherapy have included the use of anti-PD-1 monoclonal antibodies. SUMMARY The mainstay of management of temporal bone disease involves surgical resection. Early-stage tumours classified according to the Pittsburgh staging tool can often be treated with lateral temporal bone resection, whereas late-stage tumours might need subtotal or total temporal bone resection. Parotidectomy and neck dissection might also be indicated if there is a risk of occult regional disease. Recent advances in immunotherapy have been promising, particularly around anti-PD-1 inhibitors. However, larger clinical trials will be required to test the extent of efficacy, particularly around combination use with surgery.
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Affiliation(s)
- Shravan Gowrishankar
- Department of Otolaryngology - Head & Neck Surgery, Cambridge University Hospitals NHS Trust
| | - Daniele Borsetto
- Department of Otolaryngology - Head & Neck Surgery, Cambridge University Hospitals NHS Trust
| | - John Marinelli
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ben Panizza
- Department of Otolaryngology - Head & Neck surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Feng Y, Li F, Wang J, Xu L, Kong D, Sun W, Shi X, Li W, Wu Q, Zhang Y, Dai C. Risk Factors for Locoregional Recurrence and Distant Metastasis in 143 Patients with Adenoid Cystic Carcinoma of the External Auditory Canal. Clin Oncol (R Coll Radiol) 2024; 36:e40-e50. [PMID: 37872041 DOI: 10.1016/j.clon.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 08/22/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
AIMS Adenoid cystic carcinoma (ACC) grows slowly and is characterised by potential recurrence and metastasis to distant organs. This study aimed to evaluate the risk factors for locoregional recurrence (LRR) and distant metastasis in patients with ACC of the external auditory canal (EAC). MATERIALS AND METHODS Demographic, pathological, therapeutic and survival data of 143 patients with EAC ACC were reviewed in this study. Univariate and multivariate Cox proportional hazard regression analyses were carried out to determine the risk factors for LRR and distant metastasis. Factors associated with overall survival after LRR and distant metastasis were also analysed. RESULTS During a median follow-up of 49 months, 31 of 143 patients were observed with LRR and 34 developed distant metastasis. Bone invasion and histological subtype were independent risk factors for locoregional recurrence-free survival. T stage and LRR were independent risk factors for distant metastasis-free survival. Salvage surgery and adjuvant radiotherapy or chemoradiotherapy for LRR resulted in better survival, whereas extrapulmonary metastasis and LRR were associated with a higher risk of poor survival after distant metastasis. CONCLUSION Patients with distant metastases, especially those with LRR, are at significant risk of poor prognosis. Our findings emphasise the importance of long-term regular follow-up and recommend surgical intervention with radiotherapy for recurrent EAC ACC.
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Affiliation(s)
- Y Feng
- Department of Otology and Skull Base Surgery, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; Key Laboratory of Hearing Medicine, Ministry of Health, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; Department of Otolaryngology, Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - F Li
- Department of Otology and Skull Base Surgery, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; Key Laboratory of Hearing Medicine, Ministry of Health, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - J Wang
- Department of Otology and Skull Base Surgery, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; Key Laboratory of Hearing Medicine, Ministry of Health, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - L Xu
- Department of Pathology, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - D Kong
- Department of Otology and Skull Base Surgery, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; Key Laboratory of Hearing Medicine, Ministry of Health, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - W Sun
- Department of Otology and Skull Base Surgery, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; Key Laboratory of Hearing Medicine, Ministry of Health, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; Department of Otolaryngology, Chongqing General Hospital, Chongqing, China
| | - X Shi
- Department of Otology and Skull Base Surgery, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; Key Laboratory of Hearing Medicine, Ministry of Health, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - W Li
- Department of Otology and Skull Base Surgery, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; Key Laboratory of Hearing Medicine, Ministry of Health, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Q Wu
- Department of Otology and Skull Base Surgery, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; Key Laboratory of Hearing Medicine, Ministry of Health, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Y Zhang
- Department of Otology and Skull Base Surgery, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; Key Laboratory of Hearing Medicine, Ministry of Health, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.
| | - C Dai
- Department of Otology and Skull Base Surgery, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China; Key Laboratory of Hearing Medicine, Ministry of Health, Eye and Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.
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Li F, Wang J, Feng Y, Shi X, Hsueh CY, Wu Q, Kong D, Li W, Zhang Y, Dai C. The Role of Parotid Gland Invasion in Adenoid Cystic Carcinoma of the External Auditory Canal. Laryngoscope 2024; 134:419-425. [PMID: 37421252 DOI: 10.1002/lary.30855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/26/2023] [Accepted: 06/14/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE This study aimed to investigate the significance of parotid gland invasion in predicting distant metastasis of adenoid cystic carcinoma in the external auditory canal. STUDY DESIGN Single-institution retrospective cohort study. METHODS A retrospective review of patients with adenoid cystic carcinoma of the external auditory canal who underwent surgery was performed. Information on patient demographics, parotid gland invasion, tumor stage, perineural invasion, lymphovascular invasion, and follow-up data were collected and analyzed. RESULTS One hundred twenty-nine patients were identified for review. Parotid gland invasion was noted in 45 patients (34.9%). Parotid gland invasion was significantly associated with tumor stage, perineural invasion, distant metastasis, and postoperative adjuvant therapy. Distant metastasis was noted in 30 patients (23.3%). Multivariate Cox proportional hazards analysis identified parotid gland invasion as an independent risk factor for predicting distant metastasis. The 5-year distant metastasis-free survival rate was 83.6% for patients without parotid gland invasion and 61.8% for patients with parotid gland invasion (p = 0.010). CONCLUSIONS The parotid gland invasion rate is relatively high in adenoid cystic carcinoma of the external auditory canal and is significantly related to tumor stage. Parotid gland invasion is associated with worse distant metastasis-free survival. LEVEL OF EVIDENCE 4 Laryngoscope, 134:419-425, 2024.
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Affiliation(s)
- Feitian Li
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Jing Wang
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Yisi Feng
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Xunbei Shi
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Chi-Yao Hsueh
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Qianru Wu
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Dedi Kong
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Wei Li
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Yibo Zhang
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Chunfu Dai
- Department of Otorhinolaryngology, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
- Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
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Patel TR, Prince ADP, Benjamin WJ, Basura GJ. Role of the otologist/neurotologist in managing auricular and periauricular cutaneous malignancies: A 10-year otologic oncology experience. Laryngoscope Investig Otolaryngol 2023; 8:1637-1647. [PMID: 38130268 PMCID: PMC10731494 DOI: 10.1002/lio2.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023] Open
Abstract
Objective Auricular/periauricular cutaneous malignancies can be challenging to manage surgically due to the complex anatomy of the region. Otologists/neurotologists have unique skillsets that are well-suited to surgically treat these patients. We aim to highlight the role of otologists and neurotologists in providing surgical care of patients with auricular and periauricular malignancies by describing the experience of a single fellowship-trained neurotologist over a 10-year period. Methods Retrospective chart review of 387 patients with auricular and periauricular malignancy treated by a single neurotologist between 2012 and 2022 was completed. Tumor histology and procedures performed for each patient were extracted. Additional data was collected for a subset of 84 patients with complex cases requiring selective neck dissection, parotidectomy, lateral temporal bone resection, regional advancement or rotational flap reconstruction, and/or free tissue transfer reconstruction. Results Within the series of 387 patients, squamous cell carcinoma was the most common histology (42.6%, n = 165), followed by basal cell carcinoma (40.8%, n = 158), and melanoma (9.8%, n = 38). Common surgical procedures included wide local excision (61.8%, n = 239), partial/sub-total auriculectomy 18.3% (n = 71), or total auriculectomy 5.2% (n = 20). Within the 84-patient subset, median age at diagnosis was 71.9 years. Dermatologists provided most patient referrals (50.0%, n = 42). Most common tumor locations included: auricular (58.3%, n = 49), pre-auricular (21.4%, n = 18), and parotid (27.4%, n = 23). Revision surgery occurred in 22.6% of cases (n = 19), of which 26.3% (n = 5) for positive margins and 31.6% (n = 6) for recurrence. Mean follow-up was 22.8 months. Disease-specific 5-year survival was 91%. Conclusions We demonstrate the feasibility of an otologist/neurotologist incorporating the surgical management of auricular and periauricular malignancies into their practice. Level of Evidence 4.
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Affiliation(s)
- Tirth R. Patel
- Department of Otorhinolaryngology‐Head and Neck SurgeryRush UniversityChicagoIllinoisUSA
| | - Andrew D. P. Prince
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of MichiganAnn ArborMichiganUSA
| | - William J. Benjamin
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of MichiganAnn ArborMichiganUSA
| | - Gregory J. Basura
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of MichiganAnn ArborMichiganUSA
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Jang IJH, Thong JF, Teo CEH, Sommat K. Analysis of Prognostic Factors For External Auditory Canal Carcinoma: A 22-Year Experience. Laryngoscope 2023; 133:2203-2210. [PMID: 36478582 DOI: 10.1002/lary.30504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/07/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to investigate the prognostic factors and treatment outcomes in patients with the external auditory canal (EAC) squamous cell carcinoma (SCC). METHODS All patients diagnosed with EAC SCC and treated with curative intent at a single tertiary institution were retrospectively reviewed over a 22-year period. Treatment modalities included surgery with adjuvant treatment or definitive radiotherapy. The primary endpoints were overall survival (OS) and disease-specific survival (DSS). RESULTS There were 51 patients in our cohort. The 5-year OS and DSS were 64.0% ± 7.0% and 72.0% ± 7.0% respectively. Patients in the surgical arm and RT arm showed no significant difference in OS, DSS, and LRFS (p = 0.075, 0.062, 0.058 respectively). Compared to other routes of spread within the temporal bone, pattern of posterior disease invasion (involving mastoid/sigmoid sinus) showed poorer OS and DSS on multivariate analysis (hazard ratio, HR4.34 and 5.88; p = 0.006 and 0.009). On multivariate analysis, the following factors were independently prognostic of poorer OS and DSS: Previous radiotherapy (HR 3.29 and 4.81, p = 0.021 and p = 0.029); Presence of facial nerve palsy (HR 3.80 and 7.63, p = 0.013 and p = 0.003); Posterior pattern of invasion (HR4.05 and 3.59, p = 0.013 and p = 0.043). Advanced modified Pittsburgh stage was not predictive of poor OS and DSS (HR1.17 and 1.17 E+5, p = 0.786 and p = 0.961). CONCLUSION Presence of previous radiotherapy, facial nerve palsy and posterior pattern of disease invasion were independent prognostic factors of poorer survival in patients with EAC SCC. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2203-2210, 2023.
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Affiliation(s)
- Isabelle J H Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jiun Fong Thong
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Constance E H Teo
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kiattisa Sommat
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
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Komune N, Kuga R, Hongo T, Kuga D, Sato K, Nakagawa T. Impact of Positive-Margin Resection of External Auditory Canal Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:4289. [PMID: 37686564 PMCID: PMC10486369 DOI: 10.3390/cancers15174289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Positive-margin resection of external auditory canal squamous cell carcinoma (EAC-SCC) is still a major cause of recurrence. The aim of this study is to examine the clinical impact of positive-margin resection of EAC-SCCs. METHODS We retrospectively reviewed 40 surgical cases with en bloc temporal bone resection of EAC-SCC at a tertiary referral center from October 2016 to March 2022. RESULTS Two-year disease-specific, overall, and disease-free survival rates for all 40 cases reviewed were 85.2%, 88.85%, and 76.96%, respectively. En bloc resection with a negative margin significantly improved patient prognosis (p < 0.001). Positive-margin resection was observed in 9/40 cases (22.5%). Insufficient assessment of preoperative images was the cause in two of these cases. Postoperative lymph node metastasis and distant metastasis were observed in cases in which vascular, lymphatic duct or perineural invasion was found on postoperative pathological examination. In addition, three cases in which no vascular, lymphatic duct, or perineural invasion was found exhibited local recurrence during the follow-up period. Of the nine positive-margin resection cases, only two showed no postoperative recurrence. CONCLUSIONS Once positive-margin resections are confirmed, cases might have a high risk of tumor recurrence, even with the addition of postoperative adjuvant chemoradiotherapy.
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Affiliation(s)
- Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (R.K.); (T.H.); (K.S.); (T.N.)
| | - Ryosuke Kuga
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (R.K.); (T.H.); (K.S.); (T.N.)
- Department of Anatomic Pathology, Pathological, Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Takahiro Hongo
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (R.K.); (T.H.); (K.S.); (T.N.)
| | - Daisuke Kuga
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan;
| | - Kuniaki Sato
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (R.K.); (T.H.); (K.S.); (T.N.)
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (R.K.); (T.H.); (K.S.); (T.N.)
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9
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Cazzador D, Franz L, Tealdo G, Carobbio ALC, Ferraro M, Mazzoni A, Marioni G, Zanoletti E. Survival Outcomes in Squamous Cell Carcinoma of the External Auditory Canal: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12072490. [PMID: 37048574 PMCID: PMC10094887 DOI: 10.3390/jcm12072490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Squamous cell carcinomas (SCC) of the external auditory canal (EAC) are rare tumors representing a surgical challenge. Current knowledge is based largely on case series; thus, the level of evidence is weak. This study sought to systematically review the available SCC of the EAC literature and to identify risk factors for overall survival (OS) and disease-specific survival (DSS). A systematic review and meta-analysis of papers searched up to December 2022 through PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted. Quality assessment of the eligible studies was done according to the Newcastle-Ottawa Scale. Pooled univariate and multivariable analyses and meta-analysis using a random-effects or fixed-effects Mantel-Haenszel model were performed. Fifteen articles (282 patients) met the inclusion criteria and were included in the quantitative analysis. The pooled multivariable analysis revealed cT3 and cT4 as independent prognostic factors for OS (p = 0.005, and p < 0.001, respectively) and DSS (p = 0.002, and p < 0.001, respectively). Local recurrence rate was 32.3%. The meta-analysis estimated significantly higher odds ratios for advanced T categories, than cT1-T2 tumors for OS and DSS (OR = 3.55; 95% CI, 1.93–6.52, and OR = 3.73; 95% CI, 2.00–6.97, respectively). In conclusion, locally advanced tumors were associated with poor prognosis. Poor outcomes mostly occurred due to local recurrence.
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10
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Katre MI, Chintale SG, Deshmukh SD, Keche PN, Dhanajkar PS. Study of Clinicopathological Presentation and Management of Malignant Tumours of the Ear and Temporal Bone at Tertiary Care Cancer Hospital. Indian J Otolaryngol Head Neck Surg 2022; 74:3662-3670. [PMID: 36742586 PMCID: PMC9895243 DOI: 10.1007/s12070-020-02346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
Tumors of the ear can be benign or malignant. They can occur on the external ear or in the ear canal, the middle ear, and inner ear. Tumors in different areas of the ear behave differently. They are rare which causes several problems in diagnosis and appropriate treatment. The purpose of this study was to analyze retrospectively the patients with malignant neoplasm of the ear. The main objectives of this study were to study the clinicopathological presentation of ear and temporal bone malignancy and to study the management of different types of malignancy of ear and temporal bone. This study is conducted at our tertiary care cancer hospital from Feb 2015 to Jan 2020. This study includes 15 patients treated for malignancy of the external and middle ear. The entire patient was thoroughly examined for malignancy. Details ENT examination was done. History of smoking and tobacco chewing asked. The patient factors considered in this study were age, sex, diagnosis, treatment (surgery, radiotherapy, and chemotherapy), complications, follow-up, and recurrence. This study includes [n = 15] patients. Due to a variety of malignant lesions of the ear and temporal bone they were classified into two groups, Superficial location lesions [n = 5] 3 of disease limited to pinna and 2 cases of primary of parotid origin involving pinna. Deep location involving external auditory meatus and middle ear [n = 12]. In this study of [n = 15] cases lowest age was 18 years. male and highest age was 75 years. male and most common age group was 56-65 years in which [n = 7] patients present. In this study we studied [n = 11] male patients and [n = 4] female patients. The most common symptom present was ear discharge [n = 8], the next common symptom was hard of hearing [n = 7]. A less common symptom was facial weakness [n = 3]. In sign, mastoid tenderness was commonest in [n = 5], and less common was facial palsy in [n = 3]. In our study of [n = 15] patients we did lateral temporal bone resection in [n = 5] patients, wide local excision of lesion in [n = 4] patients, lateral temporal bone resection with postero-lateral neck dissection with PMMC flap done in [n = 2] patients. In our study of [n = 15] cases of ear malignancy most common histopathology is squamous cell carcinoma [n = 12] cases, least were basal cell carcinoma [n = 1], melanoma [n = 1], and Rhabdomyosarcoma [n = 1]. Malignant tumors of the ear and temporal bone are rare. Neoplasm's of the external and middle ear constitutes a group of various histopathological and clinical tumors that differ in diagnostic difficulties, treatment, and prognosis. Surgery is the mainstay of treatment followed by reconstruction. Radiotherapy and chemotherapy play an adjuvant role in post-operative management in the high-risk category. Prognosis is worst as the tumor stage advances. And most of the cases diagnosis was often made in the advanced stage especially for middle ear tumors that diminished the possibility of effective treatment.
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Affiliation(s)
- Mahendra I. Katre
- Department of Head and Neck Oncosurgery, Government Cancer Hospital Aurangabad, Aurangabad, 431001 India
| | - Sambhaji G. Chintale
- Department of Otorhinolaryngology, JIIUS IIMSR, Warudi TQ Badnapur Dist., Jalna, 431202 India
- Director Cosmoent Super-Speciality Hospital and Research Center Aurangabad, Kamgar chauk cidco n3, Aurangabad, 431005 India
| | - Sunil D. Deshmukh
- Department of Head and Neck Oncosurgery, Government Cancer Hospital Aurangabad, Aurangabad, 431001 India
| | - Prashant N. Keche
- Department of Head and Neck Oncosurgery, Government Cancer Hospital Aurangabad, Aurangabad, 431001 India
| | - Pramod S. Dhanajkar
- Department of Head and Neck Oncosurgery, Government Cancer Hospital Aurangabad, Aurangabad, 431001 India
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11
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肖 龙, 刘 爱, 马 华, 江 红. [Current status of the diagnosis and treatment of temporal bone squamous cell carcinoma]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:559-565. [PMID: 35822388 PMCID: PMC10128389 DOI: 10.13201/j.issn.2096-7993.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Indexed: 06/15/2023]
Abstract
Temporal bone squamous cell carcinoma, which is rare in the clinical setting, is the most common type of temporal bone malignancy. Its rarity makes the staging, the way of temporal bone resection, the management of parotid gland and cervical lymph node, and the application of radiotherapy and chemotherapy still controversial.There is no unanimous consensus and guideline about it to date at home and abroad.This paper reviewed the recent advance in the diagnosis and treatment of temporal bone squamous cell carcinoma in the hope of providing some help and reference for the management of the disease.
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Affiliation(s)
- 龙开 肖
- 南昌大学第一附属医院耳鼻咽喉头颈外科(南昌,330006)Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - 爱国 刘
- 华中科技大学同济医学院附属同济医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Huazhong University of Science and Technology
| | - 华良 马
- 华中科技大学同济医学院附属同济医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Tongji Hospital, Huazhong University of Science and Technology
| | - 红群 江
- 南昌大学第一附属医院耳鼻咽喉头颈外科(南昌,330006)Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
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12
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Nabuurs CH, Kievit W, Leemans CR, Smit CFGM, van den Brekel MWM, Pauw RJ, van der Laan BFAM, Jansen JC, Lacko M, Braunius WW, Dai C, Shi X, Danesi G, Bouček J, Takes RP, Kunst HPM. Evaluation of subclasses for T4-classified squamous cell carcinoma of the external auditory canal. Head Neck 2022; 44:1787-1798. [PMID: 35560966 PMCID: PMC9541903 DOI: 10.1002/hed.27082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/02/2022] [Accepted: 04/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background T4‐classified squamous cell carcinoma (SCC) of external auditory canal (EAC) can potentially involve different anatomical structures, which could translate into different treatment strategies and survival outcomes within one classification. Our aim is to evaluate the clinical added value of T4‐subclasses proposed by Lavieille and by Zanoletti. Methods Retrospective data, including patients with primary operated cT4‐classified EAC SCC, was obtained from 12 international hospitals. We subclassified according to the T4‐subclasses. The treatment strategies, disease‐free survival (DFS) and overall survival per subclass were calculated. Results A total of 130 T4‐classified EAC SCC were included. We found commonly used treatment strategies per subclass according to Lavieille and the DFS seems also to differ per subclass. Subclass according to Zanoletti showed comparable treatment strategies and survival outcomes per subclass. Conclusion Our study suggests that the subclass according Lavieille might have added value in clinical practice to improve care of T4‐classified EAC SCC.
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Affiliation(s)
- Cindy H Nabuurs
- Department of Otorhinolaryngology and Head and Neck Surgery - Academic Alliance Skull Base Pathology Radboudumc & MUMC+, Radboud University Medical Center, Nijmegen, the Netherlands.,Rare Cancers, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Wietske Kievit
- Department of Otorhinolaryngology and Head and Neck Surgery - Academic Alliance Skull Base Pathology Radboudumc & MUMC+, Radboud University Medical Center, Nijmegen, the Netherlands.,Rare Cancers, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C René Leemans
- Department of Otolaryngology and Head and Neck Surgery, Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands
| | - Conrad F G M Smit
- Department of Otolaryngology and Head and Neck Surgery, Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Robert J Pauw
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Haaglanden Medical Center, The Hage, the Netherlands
| | - Jeroen C Jansen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin Lacko
- Department of Otorhinolaryngology and Head and Neck Surgery - Academic Alliance Skull Base Pathology Radboudumc & MUMC+, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Weibel W Braunius
- Department of Head and Neck Surgical Oncology, University Medical Center/Utrecht Cancer Center, Utrecht, the Netherlands
| | - Chunfu Dai
- Department of Otology & Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Xunbei Shi
- Department of Otology & Skull Base Surgery, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Giovanni Danesi
- Department of Otorhinolaryngology and Skull Base Microsurgery-Neurosciences, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Jan Bouček
- Department of Otorhinolaryngology and Head and Neck Surgery, The First Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery - Academic Alliance Skull Base Pathology Radboudumc & MUMC+, Radboud University Medical Center, Nijmegen, the Netherlands.,Rare Cancers, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology and Head and Neck Surgery - Academic Alliance Skull Base Pathology Radboudumc & MUMC+, Radboud University Medical Center, Nijmegen, the Netherlands.,Rare Cancers, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery - Academic Alliance Skull Base Pathology Radboudumc & MUMC+, Maastricht University Medical Center, Maastricht, the Netherlands
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13
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Zhong S, Zuo W. Treatment Strategies for Malignancies of the External Auditory Canal. Curr Treat Options Oncol 2022; 23:43-53. [PMID: 35167009 PMCID: PMC8891096 DOI: 10.1007/s11864-021-00931-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/30/2022]
Abstract
Malignant tumors of the external auditory canal (EAC) are rare tumors in the head and neck. Delayed diagnosis is not uncommon because the symptoms of early tumors are nonspecific. Various surgical and oncological treatment modalities have been reported. Decision-making depends on pathological feature and stage of the lesions, patient’s general condition and preference, and physician’s experience and skill. Radical surgery is widely accepted as the primary treatment of choice. Postoperative radiotherapy is used more often to improve local and regional control of the disease. Chemotherapy is usually recommended for advanced disease, residual disease, and metastasis. Prognosis is affected by multiple factors such as TNM stage, surgical margin, pathological type and differentiation of tumor, involvement of facial nerve, and so on. Although the survival rate is improved significantly over the past several decades with the development of skull base surgery, neuroradiology, anesthesiology, and oncology, it remains challenging to diagnose and treat EAC malignancies due to the rarity, the local anatomical complexity of temporal bone, and the lack of standard TNM staging system.
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Affiliation(s)
- Shixun Zhong
- Department of Otolaryngology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Wenqi Zuo
- Department of Otolaryngology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
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14
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Prevalence of occult nodal metastases in squamous cell carcinoma of the temporal bone: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:5573-5581. [PMID: 35562514 PMCID: PMC9649468 DOI: 10.1007/s00405-022-07399-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/07/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Primary: To determine the rate of occult cervical metastases in primary temporal bone squamous cell carcinomas (TBSSC). Secondary: to perform a subgroup meta-analysis of the risk of occult metastases based on the clinical stage of the tumour and its risk based on corresponding levels of the neck. METHODS A systematic review and meta-analysis of papers searched through Medline, Cochrane, Embase, Scopus and Web of Science up to November 2021 to determine the pooled rate of occult lymph node/parotid metastases. Quality assessment of the included studies was assessed through the Newcastle-Ottawa scale. RESULTS Overall, 13 out of 3301 screened studies met the inclusion criteria, for a total of 1120 patients of which 550 had TBSCC. Out of the 267 patients who underwent a neck dissection, 33 had positive lymph nodes giving a pooled rate of occult metastases of 14% (95% CI 10-19%). Occult metastases rate varied according to Modified Pittsburg staging system, being 0% (0-16%) among 12 pT1, 7% (2-20%) among 43 pT2 cases, 21% (11-38%) among 45 pT3, and 18% (11-27%) among 102 pT4 cases. Data available showed that most of the positive nodes were in Level II. CONCLUSION The rate of occult cervical metastases in TBSCC increases with pathological T category with majority of nodal disease found in level II of the neck.
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15
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Basura GJ, Smith JD, Ellsperman S, Bhangale A, Brenner JC. Targeted molecular characterization of external auditory canal squamous cell carcinomas. Laryngoscope Investig Otolaryngol 2021; 6:1151-1157. [PMID: 34667860 PMCID: PMC8513438 DOI: 10.1002/lio2.654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/23/2021] [Indexed: 12/14/2022] Open
Abstract
HYPOTHESIS Squamous cell carcinomas (SCC) of the external auditory canal (EAC) may harbor unique genomic alterations that may explain aggressive behavior and differentiate these tumors from cutaneous SCCs of other subsites. BACKGROUND EAC SCCs arise in a non-ultraviolet-exposed region of the head and neck, are often locally aggressive and may metastasize to lymph nodes or distant sites. The genomic alterations underlying cutaneous SCC of other sites are well-documented; however, mutational profiles of EAC SCC are less well characterized and may contribute to the unique anatomic site, high rates of recurrence and tumor spread. We performed targeted sequencing of a cohort of primary EAC SCCs to identify recurring and potentially targetable genomic alterations. METHODS Genomic DNA was extracted from formalin-fixed paraffin-embedded specimens of 7 EAC SCCs and subjected to targeted DNA sequencing using a 227-gene panel. Somatic alterations and gene copy number alterations were annotated using our validated, in-house bioinformatics pipelines. RESULTS In our EAC SCCs, we found recurrent alterations in TP53 and genes of receptor tyrosine kinase (eg, EGFR, FGFR) and PI3K pathways (eg, PIK3CA), similar to cutaneous SCCs of other head and neck sites. We also observed a high frequency of telomerase reverse transcriptase amplification and DNA methyltransferase 1 alterations, both of which are rarely observed in cutaneous SCCs of other sites. CONCLUSION These data represent the first step toward precise molecular characterization of EAC SCCs that may lead to an enhanced understanding of tumor biology and modernized precision medicine approaches for unique tumors.Level of Evidence: NA.
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Affiliation(s)
- Gregory J. Basura
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Joshua D. Smith
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan Ellsperman
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Apurva Bhangale
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - John Chad Brenner
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of PharmacologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Rogel Cancer CenterUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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16
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Chang JW, Lee S, Lee JM, Moon IS, Cho YS, Cho YS, Choi JW. Occult parotid involvement in early-stage squamous cell carcinoma of the external auditory canal. Head Neck 2021; 43:2655-2662. [PMID: 33938083 DOI: 10.1002/hed.26729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/23/2021] [Accepted: 04/22/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The importance of elective parotidectomy in early-stage squamous cell carcinoma (SCC) of the external auditory canal (EAC) is not well established. METHODS A retrospective study of 43 patients with early-stage SCC of the EAC who underwent parotidectomy in conjunction with lateral temporal bone resection at three centers. RESULTS Overall occult parotid involvement (OPI) rate in early-stage SCC of the EAC was 13.9% (6/43). When considering both the anteroposterior position and the bony-cartilaginous position, patients with SCC in both the anterior wall and cartilaginous portion exhibited significantly higher OPI than other locations (37.5% vs. 0%, p = 0.001), with an increase in the OPI predictive value. CONCLUSION SCC located in either the anterior wall of the EAC or the cartilaginous portion of the EAC or both simultaneously showed a high prevalence of OPI, and elective parotidectomy should be considered in those patients.
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Affiliation(s)
- Jae Won Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Seulgi Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jeon Mi Lee
- Department of Otorhinolaryngology, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, South Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Sang Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Yang-Sun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Jin Woong Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
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17
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New proposal to revise the classification for squamous cell carcinoma of the external auditory canal and middle ear. The Journal of Laryngology & Otology 2021; 135:297-303. [PMID: 33785085 DOI: 10.1017/s002221512100089x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The prognosis of patients with advanced squamous cell carcinoma of the external auditory canal and middle ear has been improved by advances in skull base surgery and multidrug chemoradiotherapy during the last two decades. METHODS Ninety-five patients with squamous cell carcinoma of the external auditory canal and middle ear who were treated between 1998 and 2017 were enrolled. The number of patients with tumour stages T1, T2, T3 and T4 was 15, 22, 24 and 34, respectively. Oncological outcomes and prognostic factors were retrospectively investigated. RESULTS Among patients with T4 disease, invasion of the brain (p = 0.024), carotid artery (p = 0.049) and/or jugular vein (p = 0.040) were significant predictors of poor prognosis. The five-year overall survival rate of patients with at least one of these factors (T4b) was significantly lower than that of patients without these factors (T4a) (25.5 vs 65.5 per cent, p = 0.049). CONCLUSION It is proposed that stage T4 be subclassified into T4a and T4b according to the prognostic factors.
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18
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Piras G, Grinblat G, Albertini R, Sykopetrites V, Zhong SX, Lauda L, Sanna M. Management of squamous cell carcinoma of the temporal bone: long-term results and factors influencing outcomes. Eur Arch Otorhinolaryngol 2020; 278:3193-3202. [PMID: 32979119 DOI: 10.1007/s00405-020-06378-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/15/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Temporal bone squamous cell carcinoma (TBSCC) is a rare, aggressive tumor. Surgery, alone or combined with radiotherapy, represent the mainstay of treatment. To report our experience in the treatment of TBSCC and evaluate the disease-specific survival, identifying the factors influencing this outcome. MATERIALS AND METHODS A retrospective study was performed on 66 patients between 1993 and 2018. Patients were staged according to the University of Pittsburgh-modified TNM staging system. Nine cases (13.6%) were Stage I, 7 cases (10.6%) Stage II, 20 cases (30.3%) Stage III and 30 cases (45.5%) Stage IV. Twenty-four patients underwent lateral temporal bone resection (LTBR) and 42 patients underwent subtotal temporal bone resection (STBR). RESULTS One hundred percent of Stage I and II patients showed no evidence of disease (NED) after a median follow-up of 101 months (range 1-289 months). NED resulted in 88.2% of Stage III (mean follow-up 80.3 months; range 8-257) and 46.4% of stage IV (mean follow-up 50.6 months; range 3-217). Pittsburgh Stage or involvement of mastoid, facial nerve, medial wall of the middle ear, temporomandibular joint and middle fossa dura emerged as negative prognostic factors. The highest mortality rate occurred in the first 2 years after treatment, due to local recurrence. CONCLUSIONS Prognosis of TBSCC can be excellent in early stage tumors, employing a LTBR. In more advanced cases, prognosis is poor. STBR with adjuvant radiotherapy represents the treatment of choice, offering acceptable survival rates. Given the rarity of the pathology, many controversies still exist concerning optimal management.
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Affiliation(s)
- Gianluca Piras
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Via Emmanueli 42, 29121, Piacenza-Rome, Italy.
- Casa Di Cura "Piacenza" S.P.A., Piacenza, Italy.
| | - Golda Grinblat
- Hillel Yaffe Medical Center, Affiliated to Technion University, Haifa, Israel
| | - Riccardo Albertini
- Department of Otolaryngology, Head and Neck Surgery, Bologna, Italy
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Vittoria Sykopetrites
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Via Emmanueli 42, 29121, Piacenza-Rome, Italy
- Casa Di Cura "Piacenza" S.P.A., Piacenza, Italy
| | - Shi-Xun Zhong
- Department of Otolaryngology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Lorenzo Lauda
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Via Emmanueli 42, 29121, Piacenza-Rome, Italy
- Casa Di Cura "Piacenza" S.P.A., Piacenza, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico and Mario Sanna Foundation, Via Emmanueli 42, 29121, Piacenza-Rome, Italy
- Casa Di Cura "Piacenza" S.P.A., Piacenza, Italy
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19
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Xie B, Wang M, Zhang S, Liu Y. Parotidectomy in the management of squamous cell carcinoma of the external auditory canal. Eur Arch Otorhinolaryngol 2020; 278:1355-1364. [PMID: 32651676 DOI: 10.1007/s00405-020-06191-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate optimal approaches for appropriate removal of the parotid gland in the management of squamous cell carcinoma (SCC) of the external auditory canal (EAC) at different tumor stages. METHODS In total, 39 patients with SCC of EAC treated at the Second Affiliated Hospital of Nanchang University between September 2003 and April 2019 were enrolled in this study. All patients underwent lateral temporal bone resection or subtotal temporal bone resection. Total parotidectomy was performed in patients with direct parotid invasion. Superficial parotidectomy was performed in patients with parotid node metastasis and patients with advanced stages without evidence of parotid involvement. RESULTS The mean follow-up period was 68.7 months. Local recurrences or distant metastases occurred in five patients (12.8%). The 5-year overall survival rate was 78.4%. The 5-year survival rate was 100% in early stage (T1 and T2) patients, and 58.9 and 50.0% in patients staged III and IV, respectively. Direct parotid invasion was observed in only advanced-stage patients, while parotid node metastasis was noted in both early and advanced-stage patients preoperatively. There were no significant differences (χ2 = 0.1026; p = 0.749) between different tumor primary locations. However, soft tissue or preauricular organs became vulnerable once the anterior wall was infiltrated or eroded. CONCLUSION Parotid management is important for achieving safer and wider tumor-free margins. Total parotidectomy should be mandatory for all advanced-staged (T3 and T4) patients. An optimal decision for parotid management in early stages depends on the infiltration or erosion of the anterior wall of the EAC.
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Affiliation(s)
- Bingbin Xie
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, Jiangxi Province, China.,Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, 330006, China
| | - Meiqun Wang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, Jiangxi Province, China.,Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, 330006, China
| | - Shaorong Zhang
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, Jiangxi Province, China.,Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, 330006, China
| | - Yuehui Liu
- Department of Otolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, 1 Minde Road, Nanchang, 330006, Jiangxi Province, China. .,Jiangxi Biomedical Engineering Research Center for Auditory Research, Nanchang, 330006, China.
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20
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Mehta GU, Muelleman TJ, Brackmann DE, Gidley PW. Temporal bone resection for lateral skull-base malignancies. J Neurooncol 2020; 150:437-444. [PMID: 32108295 DOI: 10.1007/s11060-020-03445-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/25/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Malignancies involving the temporal bone are increasingly common and require specialized multi-disciplinary care. Given this complex location, involvement of the lateral skull base and local neurovascular structures is common. In this review we discuss general principles for temporal bone resection, as well as alternative and complementary surgical approaches that should be considered in the management of patients with temporal bone cancer. METHODS A comprehensive review on literature pertaining to temporal bone resection was performed. RESULTS The primary surgical strategy for malignancies of the temporal bone is temporal bone resection. This may be limited to the ear canal and tympanic membrane (lateral temporal bone resection) or may include the otic capsule and its contents (subtotal temporal bone resection), and/or the petrous apex (total temporal bone resection). Management of adjacent neurovascular structures including the facial nerve, the carotid artery, and the jugular bulb/sigmoid sinus should be considered during surgical planning. Finally, adjunctive procedures such as parotidectomy and neck dissection may be required based on tumor stage. CONCLUSIONS Temporal bone resection is an important technique in the treatment of lateral skull-base malignancies. This strategy should be incorporated into a multi-disciplinary approach to cancer.
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Affiliation(s)
- Gautam U Mehta
- Division of Neurosurgery, House Institute, 2100 West 3rd Street, Ste 111, Los Angeles, CA, USA.
| | | | | | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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21
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Appelbaum EN, Gross ND, Diab A, Bishop AJ, Nader ME, Gidley PW. Melanoma of the External Auditory Canal: A Review of Seven Cases at a Tertiary Care Referral Center. Laryngoscope 2020; 131:165-172. [PMID: 32065414 DOI: 10.1002/lary.28548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/23/2019] [Accepted: 01/16/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVES/HYPOTHESIS Examine the presentation and management characteristics of seven patients with melanoma of the external auditory canal (EAC). STUDY DESIGN Retrospective case series and review of the relevant literature. METHODS Records of seven patients from 2003 to 2017 with melanoma of the EAC were reviewed for characteristics of presentation, subsequent management, and outcomes. A thorough review of relevant literature is presented. RESULTS The median age is 52 years, with four females. The average Breslow depth was 3.6 mm, with five patients having a Clark level IV or greater on presentation. Six patients underwent lateral temporal bone resection, and one patient underwent wide local excision of the cartilaginous canal. Sentinel lymph node biopsy (SLNB) was performed in three patients. Three patients experienced distant recurrence an average of 20 months following primary therapy. Median follow-up was 21 months. At last follow-up, four were free of disease, one had active disease, and two were deceased from melanoma. CONCLUSIONS This is the largest series and the first to report the use of SLNB for patients with EAC melanoma in the peer-reviewed literature. Patients with external auditory canal melanoma present with higher Breslow thickness and stage relative to all external ear melanomas. Management should include wide local excision, which entails lateral temporal bone resection when the bony ear canal is involved. SLNB has a critical role in identifying patients with early metastatic disease. Postoperative radiation therapy should be considered for patients with high-risk features to reduce the risk of locoregional relapse. Chemotherapy, and especially immunotherapy, has an emerging role for this disease. LEVEL OF EVIDENCE 4 Laryngoscope, 131:165-172, 2021.
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Affiliation(s)
- Eric N Appelbaum
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neil D Gross
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adi Diab
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J Bishop
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paul W Gidley
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
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Acharya PP, Sarma D, McKinnon B. Trends of temporal bone cancer: SEER database. Am J Otolaryngol 2020; 41:102297. [PMID: 31727339 DOI: 10.1016/j.amjoto.2019.102297] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This retrospective review aims to analyze epidemiological trends related to temporal bone cancer, and primarily of the squamous cell subtype. Potential trends analyzed included age, gender, and geographical location. DATA SOURCES This retrospective review analyzed data found in the National Cancer Institute's SEER Database for cases of carcinomas of the middle ear. Cases were selected between 1975 and 2016 and using the primary site of Middle Ear (Site code C30.1), and then narrowed using additional variables, which included age, sex, and state-county. Languages covered included English. DATA EXTRACTION The extracted data was entered into an Excel spreadsheet for further analysis in SPSS Version 25. DATA SYNTHESIS An Analysis of Covariance (ANCOVA) and a Bonferroni correction were applied to the data for further analysis of significant trends. The data was then placed into tables outlining the distribution of cases among select patient characteristics of age and sex, and significant age group pairwise comparisons. CONCLUSIONS Age at diagnosis of temporal bone cancer is strongly associated with the prevalence of temporal bone cancer. We urge providers to consider subtypes of temporal bone cancer, including squamous cell carcinoma, when evaluating older adults with risk factors for temporal bone cancer and an abnormal physical exam.
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Affiliation(s)
- Pankti P Acharya
- Rowan University School of Osteopathic Medicine, United States of America.
| | - Deeksha Sarma
- Drexel University College of Medicine, United States of America
| | - Brian McKinnon
- Drexel University College of Medicine, United States of America.
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Lovin BD, Gidley PW. Squamous cell carcinoma of the temporal bone: A current review. Laryngoscope Investig Otolaryngol 2019; 4:684-692. [PMID: 31890889 PMCID: PMC6929568 DOI: 10.1002/lio2.330] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The rarity of temporal bone squamous cell carcinoma (TBSCC) precludes a clear understanding of the disease and approach to its management. This review provides general background on the disease and discusses the current and emerging oncologic and rehabilitative management options. DATA SOURCES PubMed literature review. METHODS A review of the current literature was conducted to assess and collate up-to-date information regarding TBSCC management. RESULTS TBSCC is a rare and aggressive disease arising in the ear canal, temporal bone, or extratemporal sites. Prior radiation, chronic ear disease, or habitual ear picking may contribute to primary disease development. Because the symptoms of TBSCC and benign otologic disease are similar, TBSCC diagnosis may be delayed, allowing the tumor time to spread throughout the anatomically intricate temporal bone. The extent of the disease is determined based on imaging and is usually staged with the Pittsburgh Staging System. Temporal bone resection with parotidectomy and neck dissection is the current standard of care. Survival is generally good for early disease and poor for advanced disease, but chemotherapy is emerging as a promising treatment option. Auditory rehabilitation with osseointegrated hearing aids is recommended at initial oncologic resection. CONCLUSIONS The knowledge of and outcomes for TBSCC have improved with time, but because of the aggressive nature of the disease and the anatomic intricacy of the temporal bone, TBSCC treatment is complex and should be delivered by a multidisciplinary team. Inter-institutional collaboration may accelerate research for this rare disease. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Benjamin D. Lovin
- Bobby R. Alford Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexas
| | - Paul W. Gidley
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexas
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24
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Magliocca KR, Ballestas SA, Baddour HM, Hudgins PA, Pradilla G, Solares CA. Update in Temporal Bone Resection Outcomes. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00229-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shinomiya H, Uehara N, Teshima M, Kakigi A, Otsuki N, Nibu KI. Clinical management for T1 and T2 external auditory canal cancer. Auris Nasus Larynx 2019; 46:785-789. [PMID: 30799138 DOI: 10.1016/j.anl.2019.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/26/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to clarify the impact of superficial parotidectomy and postoperative radiotherapy (PORT) for the surgical treatment of early stage squamous cell carcinoma (SCC) in external auditory canal (EAC). MATERIALS AND METHODS Thirty-seven patients with T1 (n = 14) or T2 (n = 19) SCC in EAC treated between 2000 and 2016 at Kobe University Hospital were enrolled in this study. Thirty-three patients were operated with sleeve resection or lateral temporal bone resection. RESULTS The 5-year overall survival and disease-specific survival rates were 95% and 100%, respectively. Surgical margin was positive in 4 patients, who were treated by PORT and have been alive without disease. Prophylactic superficial parotidectomy was simultaneously performed at the time of initial surgery in 15 patients, in whom no lymph node (LN) metastasis was observed. Among the other 22 patients, regional recurrence in parotid LN was observed in one patient, who was successfully salvaged by total parotidectomy. Potential parotid lymph node metastasis rates of T1 and T2 SCC in EAC was 0% (0/14) and 5% (1/19) respectively. CONCLUSIONS Complete resection without positive surgical margins is essential for the treatment of the patients with T1 and T2 ear cancers. Prophylactic superficial parotidectomy or neck dissection is not mandatory for T1 and T2 diseases, as long as precisely extent of disease is assessed preoperatively. PORT should be performed for the patients with positive surgical margins. LEVELS OF EVIDENCE 4.
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Affiliation(s)
- Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan.
| | - Natsumi Uehara
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan
| | - Akinori Kakigi
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Japan
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27
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AlEnazi AS, Alwadi FA, AlOqaili YA. Clear cell variant squamous cell carcinoma of temporal bone: Case report and literature review. Int J Surg Case Rep 2018; 51:237-240. [PMID: 30218819 PMCID: PMC6138846 DOI: 10.1016/j.ijscr.2018.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/20/2018] [Indexed: 11/29/2022] Open
Abstract
Squamous cell carcinomas of the temporal bone are rare malignancies. This is a case of clear cell squamous cell carcinoma. Otalgia, otorrhea, and hearing loss are the usual presenting symptoms. This case of temporal bone SCC was aggressive in nature and presentation.
Introduction Squamous cell carcinoma (SCC) of the temporal bone is a rare malignancy. Clear cell SCC is a rare variant of SCC of temporal bone in which no clear risk factor has been suggested as possible etiology. Otalgia, otorrhea, and hearing loss are the usual presenting symptoms of SCC of the temporal bone. Presentation of case This is a case is of a 62-year-old female who presented with a 6 months’ history of experiencing intermittent left hearing disturbance, loss of balance, persistent left tinnitus, left otalgia radiating to the lateral neck and post auricular swelling. Histology showed clear cell variant, well differentiated SCC. The patient’s tumor was found to be non-resectable due to the extensive invasion. The patient was referred for palliative therapy by medical and radiation oncology, however, the patient couldn't tolerate it. One month later she passed away. Discussion SCC of the temporal bone is a challenging clinical entity. It is diagnosed mainly by clinical and radiological assessment, and deep biopsies are used to confirm the diagnosis. Temporal bone SCC is usually diagnosed late due to delayed presentation. This case of temporal bone SCC was aggressive in nature and presentation. The presentation was different from the known triad of symptoms of temporal bone SCC which is offensive otorrhea, pain, and bleeding. Conclusion This case showed a very destructive and bizarre clinical presentation but more report of cases is needed to have a better characterization of the clinical presentation and prognosis of this variant of SCC of temporal bone.
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Affiliation(s)
- Abdulaziz S AlEnazi
- Department of Otorhinolaryngology - Head and Neck Surgery, Imam Abdulrahman Bin Faisal University, KFUH, Saudi Arabia.
| | - Fahad A Alwadi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Yazeed A AlOqaili
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia.
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Evidence Based Tailored Parotidectomy in Treating External Auditory Canal Carcinoma. Sci Rep 2018; 8:12112. [PMID: 30108249 PMCID: PMC6092432 DOI: 10.1038/s41598-018-30536-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 08/01/2018] [Indexed: 11/20/2022] Open
Abstract
Carcinoma of the external auditory canal (EAC) is a rare tumor and little information is available regarding parotid gland in surgically treating EAC carcinomas. This study aimed to investigate the mode of parotid involvement in EAC carcinoma through staging and histopathological analysis, and to establish surgical guidelines for the parotid gland management when there is no clinical evidence of parotid involvement. Sixty-five patients with EAC carcinoma who underwent temporal bone resection and any type of parotidectomy simultaneously were retrospectively reviewed. The rate of direct parotid invasion and parotid nodal involvement was analyzed according to the stage and histopathological findings. Among the 65 patients, 39 were confirmed to have squamous cell carcinoma (SCC) and 26 were confirmed to have adenoid cystic carcinoma (ACC). Direct parotid invasion occurred in 7 of 39 patients with SCC, only in the advanced stages, and in 15 of 26 patients with ACC, regardless of stage. Metastasis to the parotid node was noted in 6 patients with advanced-stage SCC, whereas no patient with ACC showed parotid nodal metastasis. For adequate tumor control with low risk of surgical complications, evidence based tailored parotidectomy should be applied. With no evidence of parotid involvement, an elective parotidectomy can be excluded in early SCC, whereas a total parotidectomy is recommended for advanced SCC. In ACC, basal resection of the parotid gland rather than a superficial or total parotidectomy should be performed at all disease stages.
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Park JM, Kong JS, Chang KH, Jun BC, Jeon EJ, Park SY, Park SN, Park KH. The Clinical Characteristics and Surgical Outcomes of Carcinoma of the External Auditory Canal: A Multicenter Study. J Int Adv Otol 2018; 14:278-284. [PMID: 30256202 PMCID: PMC6354453 DOI: 10.5152/iao.2018.4952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/13/2018] [Accepted: 04/09/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the clinical characteristics and evaluate the surgical outcomes of carcinoma of the external auditory canal (CEAC). MATERIALS AND METHODS Overall, 31 patients from four multicenter hospitals, who were diagnosed and surgically treated for CEAC in 2009-2014, were enrolled for this retrospective study. Medical records were reviewed to determine cancer stage according to the Pittsburgh classification. Clinical data of age, sex, site, initial symptoms, surgery extent, postoperative complications including recurrence, follow-up period, and current patient status were collected for analysis. Five-year cumulative survival rate was obtained using Kaplan-Meier method. RESULTS At initial diagnosis, 22 patients were in the early stages (stage I: 15; stage II: 7) and 9 patients were in the advanced stages (stage III: 1; stage IV: 8). Lymph node metastasis was present in 5 patients and distant metastasis in 2. Of the 31 patients, 4 patients died (stage II: 1, stage IV: 3) during the follow-up period. Early-stage patients showed 100% 5-year estimated cumulative survival rate, whereas the advanced-stage patients showed 5-year estimated survival rate of 53.6% (p=.006). The overall survival rate of all enrolled patients was 90.3%. Although 5-year estimated disease-free survival rate of stage I was 100.0%, that for stage II was low at 30.0% because of considerable recurrences. CONCLUSION The results of this multicenter study suggest that more aggressive treatment modality, including adjuvant therapy, is necessary for patients with CEAC with Pittsburgh stage II or more.
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Affiliation(s)
- Jung Mee Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Sun Kong
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Hong Chang
- Department of Otolaryngology-Head and Neck Surgery, Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Beom Cho Jun
- Department of Otolaryngology-Head and Neck Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Ju Jeon
- Department of Otolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - So Young Park
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shi Nae Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyoung Ho Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Comparison of the University of Pittsburgh staging system and the eighth edition of the American Joint Committee on Cancer TNM classification for the prognostic evaluation of external auditory canal cancer. Int J Clin Oncol 2018; 23:1029-1037. [PMID: 29974295 DOI: 10.1007/s10147-018-1314-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The purpose was to compare survival differences between patients with external auditory canal (EAC) cancer treated according to the University of Pittsburgh modified TNM staging system and those treated in accordance with the 8th edition of the American Joint Committee on Cancer (AJCC) staging manual on the TNM staging system for cutaneous cancers of the head and neck. METHODS We performed a retrospective, single-institution review of 60 patients with EAC cancer treated with curative intent between September 2002 and March 2018. Survival outcomes were measured on the basis of the two staging systems. RESULTS The C-index values for the overall survival (OS) rate revealed that the University of Pittsburgh staging system had higher prognostic accuracy than the 8th edition of the AJCC staging system. Univariable and multivariable analysis showed that T classification according to the University of Pittsburgh staging system was an independent predictor of the OS rate (hazard ratio 5.25; 95% confidence interval 1.38-24.9; P = 0.015). Meanwhile, the AJCC staging system could not differentiate T2 from T3-4 cancers. CONCLUSION The University of Pittsburgh staging system for patients with EAC cancer is a valuable tool for use in clinical decision-making and predicting survival outcome.
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Muelleman T, Chowdhury NI, Killeen D, Sykes K, Kutz JW, Isaacson B, Staecker H, Lin J. Effect of Piecemeal vs En Bloc Approaches to the Lateral Temporal Bone on Survival Outcomes. Otolaryngol Head Neck Surg 2018; 158:716-720. [DOI: 10.1177/0194599818758994] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Lateral temporal bone resection (LTBR) has traditionally been performed en bloc in accordance with oncologic principles. Occasionally, this is not possible due to a low tegmen or lateralized vasculature. We sought to determine if outcomes of piecemeal and en bloc LTBR are comparable. Study Design Retrospective review. Setting Two academic medical centers. Subjects and Methods Multi-institutional retrospective cohort study. Current Procedural Terminology codes were used to identify patients with T1 to T3 squamous cell carcinoma of the external auditory canal (EAC) who underwent LTBR from 2005 to 2015. Kaplan-Meier curves were constructed to compare total survival between the 2 treatment approaches. Pairwise comparisons were performed using χ2 and Fisher exact tests (significance at P = .05), as appropriate. Results Twenty-five patients were identified. Ten patients underwent en bloc LTBR; 15 underwent piecemeal LTBR. Median follow-up time was 11 months (range, 1-60 months). There was not a significant difference in overall survival between en bloc (38.9 months; 95% confidence interval [CI], 22.7-55.2) compared to piecemeal (37.5 months; 95% CI, 21.1-53.9) procedures ( P = .519). Estimates of disease-free survival also did not reveal statistically significant differences: estimated mean disease-free survival was 48.1 months (95% CI, 33.7-62.6) in en bloc patients and 32.5 months (95% CI, 17.1-47.8) in piecemeal patients ( P = .246). Conclusion These data suggest that piecemeal resection can be considered for cases of squamous cell carcinoma involving the external auditory canal where anatomic constraints preclude a safe en bloc resection. Larger studies or studies with a longer follow-up time may provide improved insight into survival comparisons.
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Affiliation(s)
- Thomas Muelleman
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Naweed I. Chowdhury
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Daniel Killeen
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kevin Sykes
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - J. Walter Kutz
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Brandon Isaacson
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Hinrich Staecker
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - James Lin
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
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Liu H, Zhang Y, Zhang T, Li F, Dai C. Correlation between the pathology and clinical presentations in patients with adenoid cystic carcinoma of the external auditory canal. Head Neck 2017; 39:2444-2449. [PMID: 28963786 DOI: 10.1002/hed.24915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/21/2017] [Accepted: 07/11/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to analyze the correlation between the pathology and clinical presentations in patients with adenoid cystic carcinoma (ACC) of the external auditory canal. METHODS Twenty-nine patients with ACC of the external auditory canal who underwent surgery were retrospectively reviewed. RESULTS Fifty percent of patients with solid pattern disease had recurrences, followed by those with cribriform (33%) and tubular (0%) pattern. Perineural invasion was common (55%), and occurred most frequently in the solid subtype (67%). The rate of otalgia was less in patients with perineural invasion (31% vs 46%). Most tumors (59%) involved the parotid gland, but it was not seen on preoperative MRI (35%). CONCLUSION The solid subtype presents the worst prognosis, and is prone to perineural invasion. Despite frequently occurring in ACC of the external auditory canal, perineural invasion may not be associated with otalgia. In ACC of the external auditory canal, high rates of occult parotid involvement support adjunctive superficial parotidectomy.
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Affiliation(s)
- Hongyan Liu
- Department of Otology and Skull Base Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yibo Zhang
- Department of Otology and Skull Base Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Ting Zhang
- Department of Otology and Skull Base Surgery, The First Hospital Affiliated to Xi'an Jiaotong University, Xian, People's Republic of China
| | - Feitian Li
- Department of Otology and Skull Base Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, People's Republic of China
| | - Chunfu Dai
- Department of Otology and Skull Base Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, People's Republic of China.,Key Laboratory of Hearing Medicine, Ministry of Health, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, People's Republic of China
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Liu H, Dai C, Wu Q, Liu H, Li F. Expression profiling of long noncoding RNA identifies lnc-MMP3-1 as a prognostic biomarker in external auditory canal squamous cell carcinoma. Cancer Med 2017; 6:2541-2551. [PMID: 28960885 PMCID: PMC5673923 DOI: 10.1002/cam4.1213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 01/12/2023] Open
Abstract
Our previous studies suggested external auditory canal squamous cell carcinoma (EACSCC) is a rare malignancy with heterogeneous outcomes. This study aimed to identify lncRNA profile of EACSCC and determine the clinical application. Differential expression genes (DEGs) were investigated in EACSCC by whole transcriptome lncRNA arrays (GPL23178). RT‐PCR was used to quantify the microarray data. Bioinformatics analyses were performed to evaluate DEGs regulations in gene ontology and cellular pathways. Fluorescence in situ hybridization (FISH) was utilized to validate lncRNA expression. The overall survival was determined by Kaplan–Meier and log‐rank analyses. Our microarrays data had been submitted to Gene Expression Omnibus (GSE98912). We identified 5621 DEGs (3185 mRNAs, 2436 lncRNAs) in EACSCC. Lnc‐MMP3‐1 was the top one upregulated lncRNA in EACSCC with fold change of 237.2 (P < 0.001). RT‐PCR results showed similar expression levels as microarrays data. Bioinformatics analyses indicated development of EACSCC was involved in aberrant alternations of multiple biological processes and cellular pathways. FSIH assays also found lnc‐MMP3‐1 was significantly differentially overexpressed in EACSCC (P < 0.001). Tumor lnc‐MMP3‐1 levels were closely associated with differentiation degree (P = 0.016), tumor invasion (P = 0.015) and TNM stage (P = 0.015). Moreover, lnc‐MMP3‐1 expression was a significant prognostic factor in EACSCC (χ2 = 4.276, P = 0.039). The study is the first screening and analysis of lncRNAs profile in EACSCC and provides new insights into pathogenesis of this rare disease. Our findings offered convincing evidences that lnc‐MMP3‐1 is a novel survival predictor of EACSCC patients.
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Affiliation(s)
- Hong Liu
- Department of Otology and Skull Base Surgery, Hearing Research Key Lab of Health Ministry of China, Eye & Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Chunfu Dai
- Department of Otology and Skull Base Surgery, Hearing Research Key Lab of Health Ministry of China, Eye & Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Qianru Wu
- Department of Otology and Skull Base Surgery, Hearing Research Key Lab of Health Ministry of China, Eye & Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Hongyan Liu
- Department of Otology and Skull Base Surgery, Hearing Research Key Lab of Health Ministry of China, Eye & Ear Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Feitian Li
- Department of Otology and Skull Base Surgery, Hearing Research Key Lab of Health Ministry of China, Eye & Ear Nose and Throat Hospital, Fudan University, Shanghai, China
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Abstract
OBJECTIVE We aimed to evaluate the prognostic factors and efficacy of treatment modalities for patients with temporal bone cancer, and to determine if definitive chemoradiotherapy (CRT) for advanced-stage disease can provide a substitute for highly invasive surgeries. STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. PATIENTS Sixty-six patients with previously untreated squamous cell carcinoma of the temporal bone treated with curative intent between April 1997 and March 2015. INTERVENTION Surgery alone, radiotherapy (RT) alone, surgery followed by RT or definitive CRT. MAIN OUTCOME MEASURE The overall survival (OS) rate. RESULTS The 5-year OS rate for each T classification was 100% for T1, 76.2% for T2, 55.6% for T3, and 36.7% for T4. Univariable and multivariable analysis showed that T classification was an independent predictor of the OS rate (hazard ratio 5.66; 95% confidence interval 1.51-27.0; p = 0.015). Analysis by treatment modality revealed that the 5-year OS rate for patients with T1-2 was 100% for surgery and 81.3% for RT alone. The rate for patients with T3-4 was 52.1% for definitive CRT and 55.6% for surgery followed by RT with or without chemotherapy. CONCLUSIONS Patients with T1-2 benefited from surgical intervention without significant morbidity or mortality. Our findings also suggested that definitive CRT might be appropriate as the first-line treatment for T3-4, especially in cases with unresectable tumors.
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Murai T, Kamata SE, Sato K, Miura K, Inoue M, Yokota N, Ohta S, Iwabuchi M, Iwata H, Shibamoto Y. Hypofractionated Stereotactic Radiotherapy for Auditory Canal or Middle Ear Cancer. Cancer Control 2017; 23:311-6. [PMID: 27556672 DOI: 10.1177/107327481602300315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Stereotactic radiotherapy (SRT) may represent a new treatment option for individuals with auditory canal or middle ear cancer. METHODS Study participants with pathologically proven ear cancer were treated with SRT (35 Gy for 3 fractions or 40 Gy for 5 fractions) as first-line therapy. When local tumor recurrence developed following SRT, subtotal temporal bone resection and postoperative chemoradiotherapy were performed as salvage treatment. Boluses were used for the initial 14 study patients. RESULTS Twenty-nine study participants were enrolled and staged with T1 (n = 3), T2 (n = 7), T3 (n = 14), or T4 disease (n = 5). Three-year overall survival rates were 69% for T1/2 disease, 79% for T3 disease, and 0% for T4 disease. Three-year local control rates were 70% for T1/2 disease, 50% for T3 disease, and 20% for T4 disease. Grade 2 or higher dermatitis or soft-tissue necrosis occurred more frequently in study patients treated with boluses (8/14 vs 2/15; P = .02). Salvage treatment was safely performed for 12 recurrent cases. CONCLUSIONS These results suggest that SRT outcomes are promising for patients with ear cancer (? T3 disease). The rate of toxicity was acceptable in the study patients treated without boluses. Outcomes of salvage surgery and postoperative radiotherapy following SRT were also encouraging.
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Affiliation(s)
- Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
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Wierzbicka M, Niemczyk K, Bruzgielewicz A, Durko M, Klatka J, Kopeć T, Osuch-Wójcikiewicz E, Pietruszewska W, Szymański M, Szyfter W. Multicenter experiences in temporal bone cancer surgery based on 89 cases. PLoS One 2017; 12:e0169399. [PMID: 28225795 PMCID: PMC5321293 DOI: 10.1371/journal.pone.0169399] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/13/2016] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To present outcomes of extensive surgery: lateral, subtotal, total petrosectomies in patients with temporal bone invasion resulting from specific primary cancers. STUDY DESIGN Retrospective case review. SETTING Four tertiary referral centers. MATERIAL 89 patients with cancer of the temporal bone treated between January 2006 and December 2010. INTERVENTION Multidisciplinary team approach including surgical resection, reconstruction, and postoperative radiotherapy. MAIN OUTCOME MEASURE Disease-specific survival, overall survival. RESULTS In 27.0% of the patients, relapse was reported, with an average of 6.3 months after surgery; 31 patients (34.8%) died during the follow-up. The average mortality was 22.1 months. Fifty-four patients (58.7%) stayed alive during the time of observation. The average survival time was 42.0 months. The median time of survival with relapse was 12 months (range: 1-51 months). The three-year disease-free rate was 38.0% and the overall survival rate was 58.7%. CONCLUSIONS Petrosectomy is an effective treatment for malignant temporal bone invasion. The probability of a good outcome was statistically decreased with a high T grade, positive margins, and salvage surgery. Younger age is connected with better prognosis. One of the major tasks remains to improve detection and to shorten the time to diagnosis, keeping in mind that symptoms are insidious and in younger people, the time before diagnosis was longer.
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Affiliation(s)
| | | | | | - Marcin Durko
- ENT Department, Medical University, Łódź, Poland
| | | | - Tomasz Kopeć
- ENT Department, Medical University, Poznań, Poland
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Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the work up and management of lateral skull base cancer based on the existing evidence base for this rare condition.
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Wierzbicka M, Kopeć T, Szyfter W, Buczkowska A, Borucki Ł. Efficacy of petrosectomy in malignant invasion of the temporal bone. Br J Oral Maxillofac Surg 2016; 54:778-83. [DOI: 10.1016/j.bjoms.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
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Zanoletti E, Marioni G, Franchella S, Munari S, Pareschi R, Mazzoni A, Martini A. Temporal bone carcinoma: Classical prognostic variables revisited and modern clinico-pathological evidence. Rep Pract Oncol Radiother 2016; 21:386-90. [PMID: 27330424 PMCID: PMC4899418 DOI: 10.1016/j.rpor.2015.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 06/10/2015] [Accepted: 07/23/2015] [Indexed: 11/25/2022] Open
Abstract
AIM Prognostic factors, rational management, and the ongoing investigations regarding temporal bone squamous cell carcinoma (TBSCC) have been critically reviewed. BACKGROUND TBSCC is an uncommon, aggressive malignancy. Although some progress has been made in treating this aggressive tumor, the prognosis in advanced cases remains poor. MATERIALS AND METHODS A systematic search of the literature for articles published between 2009 and October 2014 was performed using the PubMed (http://www.pubmed.gov) electronic database. RESULTS Given the particular anatomical site of TBSCC, its prognosis is significantly influenced by any direct involvement of nearby structures. The extent of the primary tumor is generally considered one of the most important prognostic factors and it is frequently related to prognosis even more strongly than N stage. For TBSCC, biomarker investigations in surgical specimens are only just beginning to appear in the oncological literature. CONCLUSION Given the particular features of TBSCC, the sub-specialty of otologic oncology seems to be emerging as a defined area of practice involving multidisciplinary team comprising oto-neurosurgeons, head and neck surgeons, plastic surgeons, oncologists, radiotherapists, dedicated radiologists, and pathologists.
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Affiliation(s)
- Elisabetta Zanoletti
- Department of Neurosciences, Otolaryngology Section, Padova University, Padova, Italy
| | - Gino Marioni
- Department of Neurosciences, Otolaryngology Section, Padova University, Padova, Italy
| | - Sebastiano Franchella
- Department of Neurosciences, Otolaryngology Section, Padova University, Padova, Italy
| | - Sara Munari
- Department of Neurosciences, Otolaryngology Section, Padova University, Padova, Italy
| | | | - Antonio Mazzoni
- Department of Neurosciences, Otolaryngology Section, Padova University, Padova, Italy
| | - Alessandro Martini
- Department of Neurosciences, Otolaryngology Section, Padova University, Padova, Italy
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da Silva AP, Breda E, Monteiro E. Malignant tumors of the temporal bone - our experience. Braz J Otorhinolaryngol 2016; 82:479-83. [PMID: 26832631 PMCID: PMC9449021 DOI: 10.1016/j.bjorl.2015.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/13/2015] [Accepted: 09/01/2015] [Indexed: 01/08/2023] Open
Abstract
Introduction Malignant tumors of the temporal bone are rare, with an estimated incidence of about 0.8–1.0 per 1,000,000 inhabitants per year. The vast majority of these tumors are squamous cell carcinomas and their treatment is eminently surgical. Objective This study is an attempt at systematizing the forms of clinical presentation, the therapeutic possibilities, and oncological outcomes of patients with malignant tumors of the temporal bone in a tertiary hospital in Portugal. Methods The authors present a retrospective study of temporal bone tumors treated and followed during otorhinolaryngology consultations between 2004 and 2014. A review of the literature is also included. Results Of the 18 patients included in the study, 16 had a primary tumor of the temporal bone, in most cases with squamous cell carcinoma histology. Of these, 13 patients were treated with curative intent that always included the surgical approach. Disease persistence was observed in one patient and local recurrence in five patients, on average 36.8 months after the initial treatment. Conclusions The anatomical complexity of the temporal bone and the close associations with vital structures make it difficult to perform tumor resection with margins of safety and thus, tumor relapses are almost always local. A high level of suspicion is crucial for early diagnosis, and stringent and prolonged follow-up after treatment is essential for diagnosis and timely treatment of recurrances.
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Zanoletti E, Lovato A, Stritoni P, Martini A, Mazzoni A, Marioni G. A critical look at persistent problems in the diagnosis, staging and treatment of temporal bone carcinoma. Cancer Treat Rev 2015; 41:821-6. [DOI: 10.1016/j.ctrv.2015.10.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/14/2015] [Accepted: 10/22/2015] [Indexed: 01/23/2023]
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Morita S, Nakamaru Y, Homma A, Sakashita T, Hatakeyama H, Masuya M, Fukuda S. Comparison of hearing outcomes after treatment for early-stage external auditory canal cancer. Head Neck 2015; 38 Suppl 1:E1110-6. [PMID: 26445914 DOI: 10.1002/hed.24168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/06/2015] [Accepted: 06/13/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the hearing outcomes after surgery with reconstruction of the external auditory canal in combination with tympanoplasty, radiotherapy (RT) alone, and surgery followed by postoperative RT for T1 to 2N0M0 external auditory canal cancer. METHODS We performed a retrospective, single-institution review of consecutive patients with early-stage external auditory canal cancer treated with surgery and/or RT between April 1997 and August 2013. Audiological data included the pretreatment hearing thresholds and those obtained at 12 months after the completion of therapy. RESULTS When we compared the functional gains for air-conduction pure-tone average thresholds and mean air-bone gaps, those in the surgery group (n = 10) were significantly higher than those in the RT (n = 13) and surgery + RT (n = 5) groups. CONCLUSION Adequate techniques for reconstruction of the external auditory canal in combination with tympanoplasty after complete surgical resection is useful for hearing preservation in addition to good survival outcomes. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1110-E1116, 2016.
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Affiliation(s)
- Shinya Morita
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akihiro Homma
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tomohiro Sakashita
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiromitsu Hatakeyama
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masayori Masuya
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Fukuda
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Clinical and pathological parameters prognostic for increased risk of recurrence after postoperative radiotherapy for temporal bone carcinoma. Head Neck 2015; 38:894-8. [DOI: 10.1002/hed.24221] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 07/10/2015] [Accepted: 07/20/2015] [Indexed: 12/23/2022] Open
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Abstract
CONCLUSION Lesions involving the jugular foramen (JF) present as various diagnoses. Pulsatile tinnitus is more common in glomus jugulare (GJ) tumors, whereas otalgia and facial nerve paresis are more prevalent in temporal bone malignancies (TBMs). Preoperative facial nerve electroneurography (ENoG) was significantly correlated with postoperative facial nerve function. OBJECTIVE To describe the diagnosis and surgical management of lesions involving the JF. METHODS The charts were reviewed for 38 patients who had lesions involving the JF, including 14 patients with TBMs, 11 with GJ tumors, 7 with cholesteatomas, 2 with facial nerve schwannomas, 2 with JF schwannomas, and 2 with cholesterol granulomas. The follow-up data were recorded. RESULTS The most frequent symptoms included hearing loss (89.47%), followed by otorrhea (47.37%) and pulsatile tinnitus (39.47%). With respect to TBMs, 57.14% of patients complained of otorrhea and otalgia, and 50.00% presented with facial nerve paresis. Among the 13 patients with facial nerve paresis, 53.85% were diagnosed with TBMs. Regarding GJ tumors, 81.82% had pulsatile tinnitus and hearing loss. Among the 25 patients with normal preoperative facial nerve function, the mean facial nerve ENoG reduction was 29.48 ± 29.15%, and the mean postoperative facial nerve score was 77.48 ± 33.13. The correlation coefficient was -0.973 (p = 0.000).
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Affiliation(s)
- Wei Li
- Otology & Skull Base Surgery Department
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Komune N, Komune S, Morishita T, Rhoton AL. Microsurgical anatomy of subtotal temporal bone resection en bloc with the parotid gland and temporomandibular joint. Neurosurgery 2015; 10 Suppl 2:334-56; discussion 356. [PMID: 24561868 DOI: 10.1227/neu.0000000000000324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subtotal temporal bone resection (STBR) has been used for half a century to remove temporal bone malignancies. However, there are few reports on the detailed anatomy involved in the resection. OBJECTIVE To describe the microsurgical anatomy of STBR combined en bloc with the resection of the parotid gland and temporomandibular joint (TMJ). METHODS Cadaveric specimens were dissected in a stepwise manner using 3× to 40× magnification. RESULTS STBR can be combined with the total parotidectomy and the resection of the TMJ if the tumor extends into the parotid gland, TMJ, or facial nerve. In this study, we describe the step-by-step microsurgical anatomy of STBR en bloc with the parotid gland and TMJ. The surgical technique described combines 3 approaches: the high cervical, subtemporal-infratemporal fossa, and retromastoid-paracondylar approaches. Combining these 3 approaches aided in efficiently completing this modified approach. CONCLUSION STBR is a complicated and technically challenging procedure. This study highlights the importance of understanding the surgical anatomy of STBR and will serve as a catalyst for improvement of the surgical technique for temporal bone resection.
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Affiliation(s)
- Noritaka Komune
- *Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida; ‡Department of Otorhinolaryngology Head and Neck Surgery, Kyushu University, Fukuoka, Japan
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Morita S, Nakamaru Y, Homma A, Sakashita T, Masuya M, Fukuda S. Hearing Preservation after Lateral Temporal Bone Resection for Early-Stage External Auditory Canal Carcinoma. Audiol Neurootol 2014; 19:351-7. [DOI: 10.1159/000362781] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/09/2014] [Indexed: 11/19/2022] Open
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Shen W, Sakamoto N, Yang L. Prognostic models to predict overall and cause-specific survival for patients with middle ear cancer: a population-based analysis. BMC Cancer 2014; 14:554. [PMID: 25081186 PMCID: PMC4129120 DOI: 10.1186/1471-2407-14-554] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 07/23/2014] [Indexed: 01/21/2023] Open
Abstract
Background The purpose of this study was to evaluate the survival outcome for middle ear cancer and to construct prognostic models to provide patients and clinicians with more accurate estimates of individual survival probability. Methods Patients diagnosed with middle ear cancer between 1983 and 2011 were selected for the study from the Surveillance Epidemiology and End Results Program. We used the Kaplan-Meier product limit method to describe overall survival and cause-specific survival. Cox proportional hazards models were fitted to model the relationships between patient characteristics and prognosis. Nomograms for predicting overall survival and cause-specific survival were built using the Cox models established. Results The entire cohort comprised 247 patients with malignant middle ear cancer. Median duration of follow-up until censoring or death was 25 months (range, 1–319 months). Five-year overall survival and cause-specific survival were 47.4% (95% Confidence Interval (CI), 41.2% to 54.6%) and 58.0% (95% CI, 51.6% to 65.3%), respectively. In multivariable analysis, age, histological subtype, stage, surgery and radiotherapy were predictive of survival. The bootstrap corrected c-index for model predicting overall and cause-specific survival was 0.73 and 0.74, respectively. Calibration plots showed that the predicted survival reasonably approximated observed outcomes. Conclusion The models represent an objective analysis of all currently available data. The resulting models demonstrated good accuracy in predicting overall survival and cause-specific survival. Nomograms should thus be considered as a useful tool for predicting clinical prognosis.
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Affiliation(s)
| | | | - Limin Yang
- Epidemiology and Clinical Research Center for Children's Cancer, National Center for Child Health and Development, Tokyo, Japan.
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Lionello M, Stritoni P, Facciolo M, Staffieri A, Martini A, Mazzoni A, Zanoletti E, Marioni G. Temporal bone carcinoma. Current diagnostic, therapeutic, and prognostic concepts. J Surg Oncol 2014; 110:383-92. [DOI: 10.1002/jso.23660] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/29/2014] [Indexed: 12/25/2022]
Affiliation(s)
- M. Lionello
- Department of Neurosciences; Otolaryngology Section; University of Padova; Padova Italy
| | - P. Stritoni
- Department of Neurosciences; Otosurgery Unit, Padova Hospital; Padova Italy
- Visiting Doctor at Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York, USA
| | - M.C. Facciolo
- Department of Neurosciences; Otolaryngology Section; University of Padova; Padova Italy
| | - A. Staffieri
- Department of Neurosciences; Otolaryngology Section; University of Padova; Padova Italy
| | - A. Martini
- Department of Neurosciences; Otosurgery Unit, Padova Hospital; Padova Italy
| | - A. Mazzoni
- Department of Neurosciences; Otosurgery Unit, Padova Hospital; Padova Italy
| | - E. Zanoletti
- Department of Neurosciences; Otosurgery Unit, Padova Hospital; Padova Italy
| | - G. Marioni
- Department of Neurosciences; Otolaryngology Section; University of Padova; Padova Italy
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