Jason A Brant1, Steven J Eliades, Jinbo Chen, Jason G Newman, Michael J Ruckenstein. 1. *Department of Otorhinolaryngology-Head and Neck Surgery, Hospitals of the University of Pennsylvania †Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Abstract
INTRODUCTION: Malignancy of the middle ear is a rare condition with limited data available for clinical guidance. STUDY DESIGN: Retrospective evaluation of a large national database. SETTING: Deidentified national cancer database. PATIENTS: Subjects with diagnosis of malignancy of the middle ear in the National Cancer Database between 2004 and 2012. MAIN OUTCOME MEASURES: Demographic information and tumor characteristics were evaluated. The primary endpoint of interest is overall survival. RESULTS: The most common histology was squamous cell carcinoma (SCC) (50%). Multivariable Cox proportional hazard analysis found the following variables had a significant negative impact on overall survival: age (HR 1.04 95% CI [1.02-1.05]), squamous cell carcinoma, not otherwise specified (NOS) (HR 2.08 95% CI [1.30-3.32]), squamous cell carcinoma, keratinizing, NOS (HR 4.20 95% CI [2.14-8.24]), embroynal rhabdomyosarcoma, NOS (HR 4.96 95% CI [1.17-21.11]), and unknown extension (HR 2.87 95% CI [1.22-6.74]). For patients of SCC who underwent surgery, 30 had positive margins and 29 underwent adjuvant radiation. For these, no survival advantage was found with the addition of chemotherapy, regardless of node status. CONCLUSION: Malignancy of the middle ear is a rare condition with prognosis that depends on histology. The most common histology, SCC, is associated with the poorest overall survival. Evaluation of large national datasets can add significantly to the understanding of such uncommon tumors.
INTRODUCTION:Malignancy of the middle ear is a rare condition with limited data available for clinical guidance. STUDY DESIGN: Retrospective evaluation of a large national database. SETTING: Deidentified national cancer database. PATIENTS: Subjects with diagnosis of malignancy of the middle ear in the National Cancer Database between 2004 and 2012. MAIN OUTCOME MEASURES: Demographic information and tumor characteristics were evaluated. The primary endpoint of interest is overall survival. RESULTS: The most common histology was squamous cell carcinoma (SCC) (50%). Multivariable Cox proportional hazard analysis found the following variables had a significant negative impact on overall survival: age (HR 1.04 95% CI [1.02-1.05]), squamous cell carcinoma, not otherwise specified (NOS) (HR 2.08 95% CI [1.30-3.32]), squamous cell carcinoma, keratinizing, NOS (HR 4.20 95% CI [2.14-8.24]), embroynal rhabdomyosarcoma, NOS (HR 4.96 95% CI [1.17-21.11]), and unknown extension (HR 2.87 95% CI [1.22-6.74]). For patients of SCC who underwent surgery, 30 had positive margins and 29 underwent adjuvant radiation. For these, no survival advantage was found with the addition of chemotherapy, regardless of node status. CONCLUSION:Malignancy of the middle ear is a rare condition with prognosis that depends on histology. The most common histology, SCC, is associated with the poorest overall survival. Evaluation of large national datasets can add significantly to the understanding of such uncommon tumors.
Authors: Cindy H Nabuurs; Wietske Kievit; Nilou Labbé; C René Leemans; Conrad F G M Smit; Michiel W M van den Brekel; Robert J Pauw; Bernard F A M van der Laan; Jeroen C Jansen; Martin Lacko; Weibel W Braunius; Shinya Morita; Małgorzata Wierzbicka; Takuma Matoba; Nobuhiro Hanai; Robert P Takes; Henricus P M Kunst Journal: Head Neck Date: 2020-08-13 Impact factor: 3.147