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. 2012 Sep;34(9):1231-9.
doi: 10.1002/hed.21883. Epub 2011 Sep 23.

Predictors of survival and recurrence after temporal bone resection for cancer

Luc G T Morris  1 , Saral Mehra, Jatin P Shah, Mark H Bilsky, Samuel H Selesnick, Dennis H Kraus
Affiliations

Predictors of survival and recurrence after temporal bone resection for cancer

Luc G T Morris et al. Head Neck. 2012 Sep.

Abstract

Background: The purpose of this study was to identify factors predictive of outcome in patients undergoing temporal bone resection (TBR) for head and neck cancer.

Methods: This was a retrospective study of 72 patients undergoing TBR. Factors associated with survival and recurrence were identified on multivariable regression.

Results: Most tumors were epithelial (81%), commonly (69%) involving critical structures. Cervical metastases were uncommon (6%). Squamous cell carcinoma (SCC) of the external auditory canal carried a high rate of parotid invasion (25%) and parotid nodal metastases (43%). The 5-year rate of overall survival (OS) was 62%; disease-specific survival (DSS), 70%; recurrence-free survival (RFS), 46%. Factors independently associated with outcome on multivariable analysis were margin status and extratemporal spread of disease to the parotid, mandible, or regional nodes. Recurrence was common (72%) in cT3-4 tumors.

Conclusions: Margin status and extratemporal disease spread are the strongest independent predictors of survival and recurrence. In SCC of the external auditory canal, high rates of parotid involvement support adjunctive parotidectomy. Risk of recurrence in T3-T4 tumors may support a role for adjuvant therapy.

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Figures

FIGURE 1
FIGURE 1
Overall rates of overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). For all cases (A), 5-year OS was 62.3%; DSS, 70.4%; RFS, 45.5%. For squamous cell carcinoma (SCC) cases (B), 5-year OS was 63.2%; DSS, 67.7%; RFS, 53.5%. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
FIGURE 2
FIGURE 2
Disease-specific survival among patients experiencing regional (neck or parotid) metastases was significantly poorer than those without regional metastases. For all cases (A), the difference was 74.8% versus 40.0% (p = .003). For SCC cases (B), the difference was 80.8% versus 18.8% (p < .0001).[Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
FIGURE 3
FIGURE 3
For all cases (A), the cumulative incidence of recurrence was significantly higher in tumors classified pT3–4 (71.5%), as compared with other tumors (22.3%, p = .02). For SCC cases (B), recurrence was higher in pT3–4 tumors (63.8%) than in p1–2 tumors (18.8%, p = .06). [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
FIGURE 4
FIGURE 4
Disease-specific survival was significantly poorer in patients experiencing recurrence than in those remaining recurrence-free (36.1% vs 96.3%, p < .0001). [Color figure can be viewed in the online issue, which is available at wiley onlinelibrary.com.]
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