Lehnerdt G, Schmitz K J, Dost P, Koch D A, Jahnke K
Universitäts-Hals-Nasen-Ohrenklinik Essen.
Laryngorhinootologie. 2005 Jul;84(7):482-6. doi: 10.1055/s-2005-861017.
According to the guidelines for cancer of the skin in the head and neck region of the German association of Otolaryngology, Head and Neck surgery squamous cell carcinoma (SCC) of the pinna are classified by using the current TNM system of skin cancer. As soon as cartilage is infiltrated, irrespective of other criteria like tumour size, SCC of the thin skin of the pinna are classified as T4 category. As therapy considerably depends on the TNM stage a review of the prognostic value of cartilage infiltration as well as other histological criteria seems to be justified.
Medical records of all patients (n = 36) being operated for SCC of the pinna between August 1988 and January 2004 at our department were retrospectively analysed with regard to a statistical correlation of histological criteria, cervical lymph node metastases and prognosis.
In 36 cases a histological re-evaluation could be performed on the original tumour samples (34 male symbol : 2 female symbol; average age was 76 years, with an age interval of 54 - 99 years). 26 SCC cases were smaller than 2 cm, 8 cases between 2 and 5 cm and 2 cases bigger than 5 cm of size. 36 % of SCC cases had infiltration of the auricular cartilage. Statistical analysis did not show a statistical correlation of either cartilage infiltration, tumour size bigger than 2 cm or 1 cm, tumour grading and tumour depth with regard to lymph node metastases.
According to our results, cartilage infiltration as single criterion of inclusion into a T4 category should be analysed cautiously. The anatomical peculiarity of the pinna where cartilage lies directly beneath very thin skin should be taken into account. A survey of a bigger group of patients e. g. as a multicenter study would be desirable for such a rare malignancy.
根据德国耳鼻咽喉头颈外科学会关于头颈部皮肤癌的指南，耳廓鳞状细胞癌（SCC）采用当前皮肤癌的TNM系统进行分类。一旦软骨受到浸润，无论肿瘤大小等其他标准如何，耳廓薄皮肤的SCC均被分类为T4期。由于治疗很大程度上取决于TNM分期，因此对软骨浸润以及其他组织学标准的预后价值进行综述似乎是合理的。
回顾性分析了1988年8月至2004年1月在我科接受耳廓SCC手术的所有患者（n = 36）的病历，以分析组织学标准、颈部淋巴结转移与预后之间的统计学相关性。
对36例患者的原发肿瘤样本进行了组织学重新评估（男34例：女2例；平均年龄76岁，年龄范围为54 - 99岁）。26例SCC病例肿瘤小于2 cm，8例在2至5 cm之间，2例大于5 cm。36%的SCC病例有耳廓软骨浸润。统计分析未显示软骨浸润、肿瘤大小大于2 cm或1 cm、肿瘤分级以及肿瘤深度与淋巴结转移之间存在统计学相关性。
根据我们的结果，应谨慎分析将软骨浸润作为纳入T4期单一标准的情况。应考虑到耳廓的解剖特点，即软骨直接位于非常薄的皮肤下方。对于这种罕见的恶性肿瘤，进行更大规模患者群体的调查，例如多中心研究，将是可取的。
