Applicability of the Pittsburgh Staging System for Advanced Cutaneous Malignancy of the Temporal Bone

Abstract

The objectives are to evaluate the applicability of the Pittsburgh staging system (PSS) (designed for primary temporal bone malignancies) to advanced periauricular cutaneous malignancies with temporal bone involvement and to study treatment outcomes and prognostic factors predicting recurrence-free survival. Ten patients with advanced periauricular cutaneous malignancy with temporal bone involvement were identified. Patients with primary temporal bone or parotid gland malignancies were excluded. All patients were clinically T4 at presentation by the American Joint Committee on Cancer (AJCC) staging system. Using Pittsburgh staging, six were T1 (stage I) and four were T4 (stage III). The mean follow-up was 13.6 months (3 to 24 months). Patients with basal cell carcinoma were managed with wide local excision and lateral temporal bone resection (WLE/LTBR) without adjuvant therapy. Two of three (66%) are alive and free of disease; one patient died of other causes. Treatment for squamous cell carcinoma patients involved multimodality therapy. Kaplan-Meier survival curves show a worse prognosis in terms of disease-specific survival for patients with higher-staged PSS tumors. This did not reach statistical significance. The PSS may provide additional prognostic information on advanced cutaneous malignancies of the temporal bone over the more widely used AJCC staging system. However, further prospective multicenter studies with larger sample size are required to validate our findings. Basal cell carcinoma was well controlled with WLE/LTBR alone without adjuvant therapy, whereas squamous cell carcinoma required multimodality therapy: WLE/LTBR and postoperative radiation with or without chemotherapy.

Predictors of Survival and Recurrence after Temporal Bone Resection for Cancer

“…The literature on temporal bone resection includes important data that have been contributed by several large series. 2,6,16,20,21,23,24 However, most of these reports have been based on patients treated over the past half-century or longer. Treatment has changed substantially during this time.…”

“…Most cohorts have been limited to squamous cell histology, and comprehensive outcomes analyses have been limited. 2,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Further complicating analysis, there is no recognized American Joint Committee on Cancer (AJCC) or Union Internationale Contre le Cancer (UICC) staging system for tumors of the external auditory canal/temporal bone, with multiple systems having been proposed. 3,16,25,26 To date, the most widely used system is the University of Pittsburgh staging system, first described in 1990 by Arriaga and colleagues 25 and modified in 2000 by Moody et al 3 Other than Pittsburgh stage and surgical margin status, no other factors have been consistently demonstrated to be associated with outcome, and multivariable analyses of factors affecting outcome have not been reported.…”

“…The most recent version of the University of Pittsburgh staging system 3 ( Table 1) was used to classify tumors, both clinically and pathologically. Periauricular cutaneous tumors invading the external auditory canal/temporal bone were classified using the Pittsburgh system 23 ; those not grossly invading the external auditory canal/ temporal bone were classified as ''unstaged'' in the Pittsburgh system, and also classified with the AJCC system. Parotid tumors involving the external auditory canal/temporal bone are classified T4 in either the Pittsburgh or the AJCC staging systems.…”

Update on Surgical Outcomes of Lateral Temporal Bone Resection for Ear and Temporal Bone Malignancies

“…6 Despite advances in the management of temporal bone malignancies, staging and prognostic predictors for tumors remain elusive. The Pittsburgh Staging Criteria proposed by Arriaga et al 7 in 1990 is widely utilized, and has been shown to correlate with prognosis in several retrospective studies, [8][9][10][11] although no significant correlation was observed in others. 11 In previous studies, obtaining negative margins as well as lymph node status have been shown to be important predictors of survival.…”

Temporal bone carcinoma: Classical prognostic variables revisited and modern clinico-pathological evidence

“…4,8 The temporal bone may be eroded by obvious extension or microscopic undetectable intra-osseus infiltration. Adjoining sites (jugular foramen, dura mater, internal carotid artery, facial nerve, parotid, condyle) may be involved by local tumor growth.…”