Prognostic Impact of Tumor Extension in Patients With Advanced Temporal Bone Squamous Cell Carcinoma
Prognostic Impact of Tumor Extension in Patients With Advanced Temporal Bone Squamous Cell Carcinoma
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DOI：
10.3389/fonc.2020.01229
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发表时间：
2020-08-07
影响因子：
4.7
通讯作者：
Nakagawa, Takashi
中科院分区：
文献类型：
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作者：
Komune, Noritaka;Miyazaki, Masaru;Nakagawa, Takashi
目的：颞骨鳞状细胞癌（TB-SCC）的罕见性阻碍了高质量临床证据的积累。我们的目的是探讨与T4 TB-SCC病例预后相关的解剖学因素。研究设计：病例系列和病历回顾。设置：两个学术三级医疗中心。对象和方法：所有TB-SCC病例的病历进行了回顾性分析，在两个机构。由此产生的数据集包含30例原发性T4癌，符合初始确定性（治愈性）治疗的条件。根据Kaplan-Meier方法计算疾病特异性生存期。考克斯比例风险模型用于识别解剖预后因素。结果：30例T4期TB-SCC的5年生存率为53.9%。单因素分析显示，肿瘤侵犯翼肌、后颅窝硬脑膜、乙状窦和听骨破坏与预后不良相关。多因素分析显示，听小骨、后颅窝硬脑膜和乙状窦的侵犯是独立的预后因素[风险比（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]。侵犯颈动脉管、岩尖、硬脑膜中窝、耳囊、翼肌、中耳的HR较高（HR > 2）。患者中存在的侵入性解剖因素越多，患者疾病特异性预后越差，差异具有统计学意义。结论：评估哪些解剖结构易受肿瘤侵袭可能对预测TB-SCC患者的预后和选择适当的治疗方案，特别是手术干预很重要。除了先前报道的因素外，中耳腔中听小骨的破坏可能是解剖学预后因素。
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.