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

Morita, Shinya; Mizumachi, Takatsugu; Nakamaru, Yuji; Sakashita, Tetsuya; Kano, Satoshi; Hoshino, Kimiko; Fukuda, Atsushi; Fujiwara, Kazutoshi; Homma, Akihiro

doi:10.1007/s10147-018-1314-3

Cited by 25 publications

(21 citation statements)

References 19 publications

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“…Studies have reported regional metastasis rates of 2.4–12% [10, 11]. The Pittsburgh staging system, originally developed for SCC, has been adopted for EAC carcinoma to attempt to establish staging guidelines, as there is no consensus among staging systems [10, 12]. Recent studies have shown that the University of Pittsburgh staging system carries higher prognostic accuracy than the latest AJCC staging system, with Pittsburgh T classification being an independent predictor of the overall survival rate, thus verifying that the system carries prognostic importance [12].…”

Section: Discussionmentioning

confidence: 99%

“…The Pittsburgh staging system, originally developed for SCC, has been adopted for EAC carcinoma to attempt to establish staging guidelines, as there is no consensus among staging systems [10, 12]. Recent studies have shown that the University of Pittsburgh staging system carries higher prognostic accuracy than the latest AJCC staging system, with Pittsburgh T classification being an independent predictor of the overall survival rate, thus verifying that the system carries prognostic importance [12]. The current patient was staged T1N0M0 based on the Pittsburgh system, thus wide local excision was sufficient, as it was a T1 tumor limited to the EAC showing clear margins by histopathology upon removal, without bony erosion or soft-tissue extension [10, 13].…”

Section: Discussionmentioning

confidence: 99%

“…The current patient was staged T1N0M0 based on the Pittsburgh system, thus wide local excision was sufficient, as it was a T1 tumor limited to the EAC showing clear margins by histopathology upon removal, without bony erosion or soft-tissue extension [10, 13]. Anterior wall erosion of the auditory canal (T2) would indicate the need for superficial parotidectomy and en bloc lateral temporal bone resection or subtotal temporal bone resection [10, 12, 13]. No radiation or neck dissection was indicated according to the Pittsburgh system, as there were no intraoperative findings suggestive of extensive disease, and no nodal spread was detected in the neck on imaging or exam [10, 12, 13].…”

Section: Discussionmentioning

confidence: 99%

“…Anterior wall erosion of the auditory canal (T2) would indicate the need for superficial parotidectomy and en bloc lateral temporal bone resection or subtotal temporal bone resection [10, 12, 13]. No radiation or neck dissection was indicated according to the Pittsburgh system, as there were no intraoperative findings suggestive of extensive disease, and no nodal spread was detected in the neck on imaging or exam [10, 12, 13].…”

Section: Discussionmentioning

confidence: 99%

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A Case of External Auditory Canal Sebaceous Carcinoma: Literature Review and Treatment Discussion

et al. 2020

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Sebaceous neoplasms are a rare type of skin cancer that may occur in any area with sebaceous glands, including the outer third of the external auditory canal. However, documentation of the tumor originating in this location is limited to scarce case reports. In this location, malignancies can invade the temporal bone, typically requiring en bloc resection and radiation therapy. We describe a case managed with limited surgical excision based on criteria for primary squamous cell carcinoma of the external auditory canal with only close observation following surgery. Margins were free of disease following excision and histology demonstrated a favorable prognosis. The patient was disease free after a follow-up period of over 3 years postoperatively. A review of relevant literature is utilized to discuss clinical characteristics, staging, treatment, and prognosis to assist in clinical decision making for these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Case of External Auditory Canal Sebaceous Carcinoma: Literature Review and Treatment Discussion

et al. 2020

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“…The low occurrence of temporal bone SCC (TB-SCC) has limited the amount of available data from both clinical and basic research. The Pittsburgh classification system is a globally popular staging system for TB-SCC, especially for the external auditory canal (EAC) carcinoma (1,2). However, this scheme may not accurately reflect tumor extension and lumps resectable and unresectable tumors in the same category: T4.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Impact of Tumor Extension in Patients With Advanced Temporal Bone Squamous Cell Carcinoma

et al. 2020

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The extreme rarity of temporal bone squamous cell carcinoma (TB-SCC) has delayed the accumulation of high-quality clinical evidence. Our objective here was to explore anatomical factors associated with the prognosis of T4 TB-SCC cases. Study Design: Case series with chart review. Setting: Two academic tertiary care medical centers. Subjects and Methods: The medical records of all TB-SCC cases were retrospectively reviewed in two institutions. The resulting data set contained 30 cases of primary T4 cancer eligible for initial definitive (curative) treatment. Disease-specific survival was calculated according to the Kaplan-Meier method. Cox proportional hazards model was used to identify anatomical prognosis factors. Results: The disease-specific 5-years survival rate of 30 cases of T4 TB-SCC was 53.9%. The tumor invasion to the pterygoid muscle, posterior fossa dura, and sigmoid sinus and destruction of the ossicles were associated with poor prognosis in univariate analysis. The multivariate analysis reveals that the invasion of the ossicles, posterior fossa dura, and sigmoid sinus is an independent prognostic factor [hazard ratio (HR): 4.528 (95% CI: 1.161-17.658), p = 0.030; HR: 5.135 (95% CI: 1.616-16.315), p = 0.006; HR: 4.292 (95% CI: 1.385-13.303), p = 0.012]. The invasion of the carotid canal, petrous apex, middle fossa dura, otic capsule, pterygoid muscle, and middle ear had a high HR (HR > 2). The more invaded anatomical factors present in patients resulted in a poorer patient disease-specific prognosis, with a statistically significant difference. Conclusions: Assessing which anatomical structures are susceptible to invasion by tumors may be important for predicting TB-SCC patient prognosis and selecting appropriate treatment planning, especially surgical intervention. In addition to previously reported factors, the destruction of the ossicles in the middle ear cavity can be an anatomical prognosis factor.

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Evaluating the prognostic contributions of TNM classifications and building novel staging schemes for middle ear squamous cell carcinoma

et al. 2021

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Background A universally acknowledged cancer staging system considering all aspects of the T‐, N‐, and M‐classifications for middle ear squamous cell carcinoma (MESCC) remains absent, limiting the clinical management of MESCC patients. Materials and Methods A total of 214 MESCC patients were extracted from the SEER (the Surveillance, Epidemiology, and End Results) database between 1973 and 2016. The relationships between patient’s characteristics and prognoses were analyzed by Kaplan–Meier and Cox proportional hazards regression models. Novel staging schemes for MESCC were designed by adjusted hazard ratio (AHR) modeling method according to the combinations of Stell’s T‐classification and the eighth AJCC N‐ and M‐classifications, of which performances were evaluated based on five criteria: hazard consistency, hazard discrimination, explained variation, likelihood difference, and balance. Results T‐classification was the most significant prognostic factor for MESCC patients in multivariable analysis (p = 0.021). The N‐ and M‐classifications also had obvious prognostic effect but were not statistically significant by multivariate analysis due to the limited metastasis events. Three novel staging schemes (AHR‐Ⅰ–Ⅲ models, different combination of T‐ and N‐classifications) and ST (solely derived from Stell’s T‐classification) were developed, among which the AHR‐Ⅰ staging scheme performed best. Conclusions Tumor extension, quantified by Stell’s T‐classification, is the most significant prognostic factor for MESCC patients. However, our AHR‐Ⅰ staging scheme, a comprehensive staging scheme that integrating T‐, N‐, and M‐classifications, might be an optimal option for clinical practitioners to predict MESCC patients’ prognosis and make proper clinical decisions.

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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

Abstract: 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.

Cited by 25 publications

References 19 publications

A Case of External Auditory Canal Sebaceous Carcinoma: Literature Review and Treatment Discussion

A Case of External Auditory Canal Sebaceous Carcinoma: Literature Review and Treatment Discussion

Prognostic Impact of Tumor Extension in Patients With Advanced Temporal Bone Squamous Cell Carcinoma

Evaluating the prognostic contributions of TNM classifications and building novel staging schemes for middle ear squamous cell carcinoma

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