Gaudet Jacques E, Walvekar Rohan R, Arriaga Moises A, Dileo Michael D, Nuss Daniel W, Pou Anna M, Hagan Joseph, Lin James
Skull Base. 2010 Nov;20(6):409-14. doi: 10.1055/s-0030-1253575.
The objectives are to evaluate the applicability of the Pittsburgh staging system (PSS) (designed for primary temporal bone malignancies) to advanced periauricular cutaneous malignancies with temporal bone involvement and to study treatment outcomes and prognostic factors predicting recurrence-free survival. Ten patients with advanced periauricular cutaneous malignancy with temporal bone involvement were identified. Patients with primary temporal bone or parotid gland malignancies were excluded. All patients were clinically T4 at presentation by the American Joint Committee on Cancer (AJCC) staging system. Using Pittsburgh staging, six were T1 (stage I) and four were T4 (stage III). The mean follow-up was 13.6 months (3 to 24 months). Patients with basal cell carcinoma were managed with wide local excision and lateral temporal bone resection (WLE/LTBR) without adjuvant therapy. Two of three (66%) are alive and free of disease; one patient died of other causes. Treatment for squamous cell carcinoma patients involved multimodality therapy. Kaplan-Meier survival curves show a worse prognosis in terms of disease-specific survival for patients with higher-staged PSS tumors. This did not reach statistical significance. The PSS may provide additional prognostic information on advanced cutaneous malignancies of the temporal bone over the more widely used AJCC staging system. However, further prospective multicenter studies with larger sample size are required to validate our findings. Basal cell carcinoma was well controlled with WLE/LTBR alone without adjuvant therapy, whereas squamous cell carcinoma required multimodality therapy: WLE/LTBR and postoperative radiation with or without chemotherapy.
目的是评估匹兹堡分期系统（PSS）（专为原发性颞骨恶性肿瘤设计）对累及颞骨的晚期耳周皮肤恶性肿瘤的适用性，并研究治疗结果及预测无复发生存的预后因素。确定了10例累及颞骨的晚期耳周皮肤恶性肿瘤患者。排除原发性颞骨或腮腺恶性肿瘤患者。根据美国癌症联合委员会（AJCC）分期系统，所有患者就诊时临床分期均为T4。采用匹兹堡分期，6例为T1（I期），4例为T4（III期）。平均随访时间为13.6个月（3至24个月）。基底细胞癌患者采用广泛局部切除和颞骨外侧切除术（WLE/LTBR），不进行辅助治疗。3例中有2例（66%）存活且无疾病；1例患者死于其他原因。鳞状细胞癌患者的治疗采用多模式疗法。Kaplan-Meier生存曲线显示，PSS分期较高的肿瘤患者在疾病特异性生存方面预后较差。这未达到统计学意义。与应用更广泛的AJCC分期系统相比, PSS可能为颞骨晚期皮肤恶性肿瘤提供额外的预后信息。然而，需要进一步开展更大样本量的前瞻性多中心研究来验证我们的发现。基底细胞癌单独采用WLE/LTBR且不进行辅助治疗就能得到良好控制，而鳞状细胞癌则需要多模式疗法：WLE/LTBR以及术后放疗，可联合或不联合化疗。
