95例外耳道及中耳鳞状细胞癌分析。

Analysis of 95 cases of squamous cell carcinoma of the external and middle ear.

作者信息

Yin Min, Ishikawa Kazuo, Honda Kouhei, Arakawa Takuya, Harabuchi Yasuaki, Nagabashi Tatsumi, Fukuda Satoshi, Taira Atsushi, Himi Tetsuo, Nakamura Narihiro, Tanaka Katuhiko, Ichinohe Manabu, Shinkawa Hideichi, Nakada Yoshihiko, Sato Hiroaki, Shiga Kiyoto, Kobayashi Toshimitsu, Watanabe Tomoo, Aoyagi Masaru, Ogawa Hiroshi, Omori Koichi

机构信息

Division of Otorhinolaryngology, Head and Neck Surgery, Department of Sensory Medicine, Akita University School of Medicine, Hondo 1-1-1, Akita 010-8543, Japan.

出版信息

Auris Nasus Larynx. 2006 Sep;33(3):251-7. doi: 10.1016/j.anl.2005.11.012. Epub 2006 Jan 20.

DOI:10.1016/j.anl.2005.11.012

PMID:16431060

Abstract

OBJECTIVE

To analyze the clinical characteristics, 5-year survival, and prognostic factors of squamous cell carcinoma (SCC) of the external and middle ear.

METHODS

A multi institutional study. Ninety five cases of patients from 10 institutions were reviewed on their age and sex distribution, initial complaints, stages, tumor locations, treatments, and outcomes. Prognostic factors were discussed based on the Pittsburgh staging system.

RESULTS

This disease seems to appear in the elderly with a peak age of 50-69 years. Males appear to be more predisposed than females with an odd ratio of 1.7. The initial complaints were not typical, while 12.6% of patients presented a history of recurrent otitis externa or chronic otitis media. Regional metastasis was recognized in 13.7% of patients, while no distant metastasis was confirmed. SCC located in the external ear could be detected in an earlier stage than that in the middle ear. The overall 5-year survival was 66.8% in total, and decreased significantly with stage. SCC in stages I and II was susceptible to each therapeutic strategy with a 5-year survival of 100%. Operation combined with radiotherapy and/or chemotherapy was the major treatment for stages III and IV SCC, while radiotherapy and chemotherapy were applied mainly for those who had been considered inappropriate for operation. The overall survival was 67.2% for stage III and 29.5% for stage IV, and operation with pathologically tumor free margin could improve the survival to 72.7% when combined with radio- and chemotherapy. Stage, completeness of operation with tumor free margin, recurrence, and metastasis have significant influence on survival.

CONCLUSION

Local infiltration seems to be the main behavior of SCC in the external and middle ear. Early diagnosis and treatment were important because SCC in the earlier stage is susceptible to be cured. For tumors of advanced stage, operation should be performed with pathologically tumor free margin, and operation combined with radiotherapy and chemotherapy could improve the survival. Tumor stage adds more influence on survival than its location. Recurrence and metastasis mainly occur in advanced stages and result in a poor survival.

摘要

目的

分析外耳道及中耳鳞状细胞癌（SCC）的临床特征、5年生存率及预后因素。

方法

一项多机构研究。回顾了来自10个机构的95例患者的年龄和性别分布、初始症状、分期、肿瘤位置、治疗方法及预后。基于匹兹堡分期系统讨论预后因素。

结果

该疾病似乎好发于老年人，高峰年龄为50 - 69岁。男性比女性更易患病，比值比为1.7。初始症状不典型，12.6%的患者有外耳道炎复发或慢性中耳炎病史。13.7%的患者出现区域转移，未证实有远处转移。外耳道SCC比中耳SCC能更早被检测到。总体5年生存率为66.8%，并随分期显著降低。I期和II期SCC对每种治疗策略均敏感，5年生存率为100%。手术联合放疗和/或化疗是III期和IV期SCC的主要治疗方法，而放疗和化疗主要应用于那些被认为不适合手术的患者。III期总体生存率为67.2%，IV期为29.5%，手术切缘病理无肿瘤残留联合放化疗时生存率可提高至72.7%。分期、手术切缘有无肿瘤残留、复发及转移对生存率有显著影响。