Essig Garth F, Kitipornchai Leon, Adams Felicity, Zarate Dannie, Gandhi Mitesh, Porceddu Sandro, Panizza Benedict
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, United States.
Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
J Neurol Surg B Skull Base. 2013 Feb;74(1):54-9. doi: 10.1055/s-0032-1331021. Epub 2012 Dec 12.
Objective To evaluate lateral temporal bone resection (LTBR) in the management of advanced cutaneous squamous cell carcinoma (SCC) with temporal bone invasion and patterns of failure. Methods This is a retrospective study of 35 patients undergoing lateral temporal bone resection for advanced cutaneous SCC at a tertiary care center between 1995 and 2006. Results The Pittsburgh tumor stage was T4 in 18 patients (51%), T3 in 5 (14%), T2 in 9 (26%), and T1 in 3 (9%). Clear margins were reported in 22 (63%) patients. Resection of the mandible and/or temporomandibular joint (TMJ) was required in 11 (31%) patients. Facial nerve involvement was seen in 10 (29%) patients. Survival outcomes at 2 and 5 years for overall survival were 72% and 49%; disease-free survival, 68% and 59%; and disease-specific survival, 79% and 62%, respectively. Pittsburgh T stage correlated significantly with disease-specific survival (p = 0.015) and margin status was significant for both disease-free survival (p = 0.0015) and disease-specific survival (p < 0.001). Conclusions Surgery with curative intent is justified for cutaneous SCC invading the temporal bone with extended LTBR. Margin status was a significant predictor of outcome. Surgeons should plan preoperatively to achieve clear margins by extending the LTBR with possible nerve resection.
评估外侧颞骨切除术（LTBR）在治疗侵犯颞骨的晚期皮肤鳞状细胞癌（SCC）中的应用及失败模式。方法：这是一项对1995年至2006年间在一家三级医疗中心接受外侧颞骨切除术治疗晚期皮肤SCC的35例患者的回顾性研究。结果：匹兹堡肿瘤分期为T4的患者有18例（51%），T3的患者有5例（14%），T2的患者有9例（26%），T1的患者有3例（9%）。22例（63%）患者报告切缘阴性。11例（31%）患者需要切除下颌骨和/或颞下颌关节（TMJ）。10例（29%）患者出现面神经受累。总体生存的2年和5年生存率分别为72%和49%；无病生存率分别为68%和59%；疾病特异性生存率分别为79%和62%。匹兹堡T分期与疾病特异性生存显著相关（p = 0.015），切缘状态对无病生存（p = 0.0015）和疾病特异性生存（p < 0.001）均有显著意义。结论：对于侵犯颞骨的皮肤SCC，采用扩大LTBR的根治性手术是合理的。切缘状态是预后的重要预测因素。外科医生应在术前计划通过扩大LTBR并可能进行神经切除来实现切缘阴性。
