Predictors of survival and recurrence after temporal bone resection for cancer

Abstract

Background The purpose of this study was to identify factors predictive of outcome in patients undergoing temporal bone resection (TBR) for head and neck cancer. Methods This was a retrospective study of 72 patients undergoing TBR. Factors associated with survival and recurrence were identified on multivariable regression. Results Most tumors were epithelial (81%), commonly (69%) involving critical structures. Cervical metastases were uncommon (6%). Squamous cell carcinoma (SCC) of the external auditory canal carried a high rate of parotid invasion (25%) and parotid nodal metastases (43%). The 5-year rate of overall survival (OS) was 62%; disease-specific survival (DSS), 70%; recurrence-free survival (RFS), 46%. Factors independently associated with outcome on multivariable analysis were margin status and extratemporal spread of disease to the parotid, mandible, or regional nodes. Recurrence was common (72%) in cT3–4 tumors. Conclusions Margin status and extratemporal disease spread are the strongest independent predictors of survival and recurrence. In SCC of the external auditory canal, high rates of parotid involvement support adjunctive parotidectomy. Risk of recurrence in T3–T4 tumors may support a role for adjuvant therapy.

Survival outcomes of patients with temporal bone squamous cell carcinoma with different invasion patterns

“…20 In SCC of the EAC, high rates of parotid involvement support the use of adjunctive parotidectomy. 23 In the present study, the overall survival rate of patients with early stage lesions (stage I and II) at 2 years was 100%, which may attribute to our aggressive surgical strategy. However, the 2-year overall survival rate for all patients was 56.9% ( Figure 5), and for stage IV patients was only 22.3%, which is lower than that reported in previous studies.…”

“…Local canal resection was recommended for early stage tumors that were confined to the cartilaginous EAC. 23 However, the thin skin of the bony ear canal increases the difficulty in achieving a negative deep margin. Once the tumor erodes the bony ear canal, an en bloc resection of the EAC is recommended.…”

“…Previous studies identified factors independently associated with outcome in multivariable analysis, including margin status and extratemporal spread of disease to the parotid, mandible, or regional nodes. 23 Otherwise, 4 patients received prior treatment but had persistent disease, whereas 4 patients had recurrent tumors at the time of referral but their treatment strategies were unclear. However, the long-term prognosis of carcinoma of the EAC mainly depends on the stage and primary treatment.…”

Concomitant chemoradiotherapy for advanced squamous cell carcinoma of the temporal bone

“…[3][4][5] On the other hand, oncologic and functional results obtained with these treatment modalities for locally advanced temporal bone cancers have not been satisfactory. 6 The 5-year survival rates for surgically treated patients with unresectable T4 dis-ease ranged from 17% to 40% 2,4-6 and are accompanied by an unfavorable quality of life for survivors because of facial palsy, hearing loss, and balance disorder. Surgical treatment for advanced disease can also lead to serious complications, such as meningitis, cerebral infarction, or brain edema.…”

Clinical and pathological parameters prognostic for increased risk of recurrence after postoperative radiotherapy for temporal bone carcinoma

“…The specificity of this panel was 92.9%; moreover, the positive predictive accuracy amounted to 90.0%, and the negative predictive accuracy to 76.5%. From a review of the available literature, dura mater involvement emerged clearly as an independent negative prognostic factor in some 1,5,18 of the few investigations in which a multivariate statistical approach was applied. In the present cohort of patients, the discriminatory power of dura mater involvement alone in predicting temporal bone SCC recurrence after PORT was distinctly lower than that of our panel of parameters, and below the threshold for acceptability, according to the Hosmer-Lemeshow scale (AUC [ROC] 5 0.692; 95% CI 5 0.498-0.862).…”