Primary temporal bone squamous cell carcinoma: Comparing the prognostic value of the American Joint Committee on Cancer TNM classification (8th edition) with the revised Pittsburgh staging system

Abstract

Background Retrospectively considering a temporal bone squamous cell carcinomas (TBSCCs) series, our aim was to compare the predictive power of the American Joint Committee on Cancer (AJCC) staging system (8th edition) with the revised Pittsburgh staging system (rPSS) in terms of disease‐free survival (DFS), disease‐specific survival (DSS), and overall survival (OS). Methods Forty‐three TBSCCs consecutively treated surgically were reviewed. The prognostic performance of AJCC and rPSS was compared. Results The areas under the curves for the prediction of DFS, DSS, and OS did not differ significantly between both staging systems (p = 0.518, p = 0.940, and p = 0.910, respectively). Harrel's C‐indexes for respectively the AJCC and rPSS were 0.76 and 0.70 for DFS, 0.73 and 0.76 for DSS, 0.66 and 0.63 for OS. Conclusion Comparable prognostic accuracy was observed between AJCC and rPSS. Levels of prognostic performance were only acceptable for both systems, according to Hosmer–Lemeshow scale. Further efforts are needed to define new TBSCC staging modalities with higher prognostic reliability.

The revised Pittsburgh staging system for middle ear squamous cell carcinoma: A challenging clinical dilemma

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We read with great interest the well-written article by Zanoletti et al, 1 which systematically compare the predictive power of the American Joint Committee on Cancer (AJCC) staging system (8th edition) with the revised Pittsburgh staging system (rPSS) in terms of prognosis for patients with temporal bone squamous cell carcinoma (TBSCC). However, we found that some of the conclusions seemed arbitrary, and further discussion is necessary.First, primary TBSCCs are actually heterogeneous carcinomas with varying origins, mainly including external auditory canal squamous cell carcinoma (EACSCC) and middle ear squamous cell carcinoma (MESCC), which are commonly investigated as a whole due to their rarity.

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“…We read with great interest the well-written article by Zanoletti et al, 1 which systematically compare the predictive power of the American Joint Committee on Cancer (AJCC) staging system (8th edition) with the revised Pittsburgh staging system (rPSS) in terms of prognosis for patients with temporal bone squamous cell carcinoma (TBSCC). However, we found that some of the conclusions seemed arbitrary, and further discussion is necessary.…”

Reply to Letter to the Editor regarding “Primary temporal bone squamous cell carcinoma: Comparing the prognostic value of the American Joint Committee on Cancer TNM classification (8th edition) with the revised Pittsburgh staging system”

“…We read with interest the comments by Mao et al 1 about our recently published investigation. 2 In several recent publications, our clinical research group on neoplasms of the temporal bone has pointed out the controversies surrounding the rational diagnostic/therapeutic/prognostic approach to primary squamous cell carcinoma of the external auditory canal. 3 This is due not only to the relative rarity of this tumor site but also in a significant part to the bias related to the heterogeneity of available case series.…”

“…is also associated with different tumor behaviors and prognoses. For this reason, in our previous investigations and also the most recent one, 2 we only considered squamous cell carcinomas arising in the skin of the external auditory canal. This decision is clearly stated in the Materials and Methods section of the study (“… All patients diagnosed with primary SCC originated from the external auditory canal …“ 2 ).…”

“…For this reason, in our previous investigations and also the most recent one, 2 we only considered squamous cell carcinomas arising in the skin of the external auditory canal. This decision is clearly stated in the Materials and Methods section of the study (“… All patients diagnosed with primary SCC originated from the external auditory canal …“ 2 ). We also stated that “peri‐auricolar area and adjoining sites” of origin were excluded, which highlighted the origin of the tumor from the external auditory canal.…”