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

Noritaka Komune,Kensuke Koike,Teppei Noda,Ryutaro Uchi,Kuniaki Sato,Shogo Masuda,Nana Akagi Tsuchihashi,Ryunosuke Kogo,Takahiro Hongo,Akio Hiwatashi,Takashi Nakagawa,Masaru Miyazaki,Koji Sagiyama

doi:10.3389/fonc.2020.01229

Noritaka Komune, Kensuke Koike + Show 11 more

Open Access

https://doi.org/10.3389/fonc.2020.01229

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Abstract

Objective: 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.

Highlights

Malignant neoplasms of the temporal bone are extraordinarily rare and account for
The final cases sampled for our retrospective cohort study consisted of 30 patients diagnosed with T4 TB-Squamous cell carcinoma (SCC)
To examine anatomical prognosis factors, we examined 17 structures in the temporal bone among T4 TB-SCC patients, including the tympanic cavity, ossicles, eustachian tube, parotid gland, middle and posterior cranial fossae, petrous apex, carotid canal, jugular foramen, otic capsule, facial nerves, the TMJ, pterygoid muscle, parapharyngeal space, sigmoid sinus, endolymphatic sac, and styloid process (Figure 1)