Retrospective Analysis Of 60 Cases Of Carcinoma Of External Auditory Canal And Middle Ear

ObjectiveTo explore the clinical manifestations, diagnosis, treatment strategies and prognostic factors of carcinoma of external auditory canal and middle ear, and to improve the survival time and life quality of patients.Methods60 patients with carcinoma of external auditory canal and middle ear in Department of ENT of Shandong Provincial Hospital from April,2005 to February,2014 were analyzed retrospectively for survival. All the patients’ tumors were pathologically confirmed. We analyzed manifestations, pathological types, imaging findings, TNM staging, therapeutic methods and follow-up information. K-M method was adopted to draw the survival curves and COX proportion hazard pattern was used to determine the correlation between survival time and prognostic factors, such as gender, age, T stages, surgical margins, lymph node metastasis, etc.ResultsThe patients were staged according to the modified Pittsburgh staging system.17 patients were classified in T1 stage,7 in T2,9 in T3,26 in T4.26 patients underwent lateral temporal bone resection,30 patients underwent subtotal temporal bone resection,2 patients underwent radical mastoidectomy,1 patient received radiotherapy alone and 1 received chemotherapy alone.Of all the 60 patients, the 5-year overall survival (OS) rate and recurrence-free system (RFS) rate were 67.0% and 59.5%, respectively. The 5-year OS and RFS rates of early-stage (T1 and T2) patients were all 100%. The 5-year OS rates of patients with T3 and T4 diseases were 76.2%,32.9%, respectively. The 5-year RFS rates of patients with T3 and T4 diseases were 62.2% and 27.3%, respectively. The 5-year OS and RFS rates of patients who underwent surgery and adjuvant radiotherapy were 84.7% and 70.0%, respectively. The 5-year OS and RFS rates of patients who underwent surgery alone were 51.3%,50.8%, respectively. In all the prognostic factors we chose, T stages, surgical margins, facial nerve paralysis, involvement of dura mater and histological type were of obvious influence on survival.Conclusion1. The prognosis of early-stage tumors is rather satisfactory, but it is much worse for patients with advanced-stage tumors. Thus, early diagnosis and treatment is vital.2. The most suitable treatment we think is en bloc surgery combined with radiotherapy. For patients with early-staged tumors, LTBR is highly recommended, and for patients with advanced-staged tumors, STBR is recommended. We think local resection, mastoidectomy and TTBR should not be used in the treatment because of obvious drawbacks.3. Pittsburgh staging system is useful in predicting the prognosis of patients. It can be used as the guide when choosing surgical procedures.4. Advanced T stages, facial nerve or dura mater involvement, squamous cell carcinoma and positive margin are the possible factors of poor prognosis. Radiotherapy is the protective factor of survival.