Department of Otorhinolaryngology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal.
Department of Otorhinolaryngology, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
Eur Arch Otorhinolaryngol. 2020 Oct;277(10):2709-2720. doi: 10.1007/s00405-020-06019-2. Epub 2020 May 4.
Evidence-based treatment recommendations for external auditory canal (EAC) carcinoma are lacking in available literature. This study aims to evaluate the clinical characteristics and long-term outcomes of EAC carcinoma in a tertiary referral centre in a period of 15 years and identify independent prognostic factors.
Retrospective observational study enrolling all patients with primary EAC carcinoma who underwent primary surgical treatment at the Portuguese Institute of Oncology (Lisbon) between 2004 and 2018. Epidemiological, clinical, histopathological and surgical data were retrieved from clinical records and analysed.
Twenty-seven patients were identified, with a median age of 77 years (range 29-92 years) and a slight female predominance (59.3%). Squamous cell carcinoma (55.6%) was the most common histological type, followed by basal cell carcinoma (40.7%) and ceruminous adenocarcinoma (3.7%). Pittsburgh tumour staging was distributed as early stage in 51.9% (I: 40.7%; II: 11.1%) and advanced stage in 48.1% (III: 29.6%; IV: 18.5%). Median follow-up period was 21 months (interquartile-range: 47). Four patients (14.8%) showed recurrence; recurrence rate was significantly higher in individuals aged < 60 years (p = 0.025) and with lymphovascular invasion (p = 0.049). Median overall survival was 88 months and estimated 2-year and 5-year overall survival rates were both 66%. Survival rates were higher in early stage patients (p = 0.021) and in those without facial palsy (p = 0.032).
Based on the available evidence in this review, individuals aged < 60, facial nerve impairment, advanced stage lesions, presence of lymphovascular invasion and squamous cell carcinoma histology are all associated with poor outcome and may be considered when discussing optimal treatment strategies in patients with EAC carcinoma.
现有文献中缺乏对外耳道（EAC）癌的循证治疗建议。本研究旨在评估 15 年来一家三级转诊中心 EAC 癌的临床特征和长期结果，并确定独立的预后因素。
回顾性观察性研究，纳入 2004 年至 2018 年期间在葡萄牙肿瘤研究所（里斯本）接受原发性 EAC 癌手术治疗的所有原发性 EAC 癌患者。从临床记录中检索并分析了流行病学、临床、组织病理学和手术数据。
共确定了 27 例患者，中位年龄为 77 岁（范围 29-92 岁），女性略占优势（59.3%）。鳞状细胞癌（55.6%）是最常见的组织学类型，其次是基底细胞癌（40.7%）和耵聍腺癌（3.7%）。匹兹堡肿瘤分期为早期 51.9%（I 期：40.7%；II 期：11.1%），晚期 48.1%（III 期：29.6%；IV 期：18.5%）。中位随访时间为 21 个月（四分位间距：47）。4 例（14.8%）患者出现复发；<60 岁的患者（p=0.025）和存在血管淋巴管侵犯的患者（p=0.049）复发率明显更高。中位总生存期为 88 个月，估计 2 年和 5 年总生存率均为 66%。早期患者（p=0.021）和无面瘫患者（p=0.032）的生存率更高。
根据本综述中的现有证据，<60 岁、面神经损伤、晚期病变、存在血管淋巴管侵犯和鳞状细胞癌组织学均与不良预后相关，在讨论 EAC 癌患者的最佳治疗策略时可考虑这些因素。
