Survival Outcomes in Squamous Cell Carcinoma of the External Auditory Canal: A Systematic Review and Meta-Analysis

Abstract

Squamous cell carcinomas (SCC) of the external auditory canal (EAC) are rare tumors representing a surgical challenge. Current knowledge is based largely on case series; thus, the level of evidence is weak. This study sought to systematically review the available SCC of the EAC literature and to identify risk factors for overall survival (OS) and disease-specific survival (DSS). A systematic review and meta-analysis of papers searched up to December 2022 through PubMed, Scopus, Web of Science, and Cochrane Library databases was conducted. Quality assessment of the eligible studies was done according to the Newcastle-Ottawa Scale. Pooled univariate and multivariable analyses and meta-analysis using a random-effects or fixed-effects Mantel-Haenszel model were performed. Fifteen articles (282 patients) met the inclusion criteria and were included in the quantitative analysis. The pooled multivariable analysis revealed cT3 and cT4 as independent prognostic factors for OS (p = 0.005, and p < 0.001, respectively) and DSS (p = 0.002, and p < 0.001, respectively). Local recurrence rate was 32.3%. The meta-analysis estimated significantly higher odds ratios for advanced T categories, than cT1-T2 tumors for OS and DSS (OR = 3.55; 95% CI, 1.93–6.52, and OR = 3.73; 95% CI, 2.00–6.97, respectively). In conclusion, locally advanced tumors were associated with poor prognosis. Poor outcomes mostly occurred due to local recurrence.

Algorithms of follow-up in patients with head and neck cancer in relation to primary location and advancement. Consensus of Polish ENT Society Board and Head Neck Experts

“…Malignant neoplasms of the temporal bone constitute a small percentage of all HNC (only 0.2%), and the local advancement of the process is associated with a poor prognosis ( 71 , 72 ). Local recurrences amount to 32.3% ( 73 ). The average rate of hidden metastases in the region II of the neck is 14%; in the local advancement, T3 is estimated at 21%.…”

“…The average rate of hidden metastases in the region II of the neck is 14%; in the local advancement, T3 is estimated at 21%. Considering the high rate of recurrences in the early postoperative period, follow-up should include a physical examination and MRI performed every 2 months in the first year, every 4 months in the second year, and every 6 months from the third to the fifth year ( 73 , 74 ). Molecular markers are not yet significant in the diagnosis and follow-up of patients with temporal bone cancer ( 75 ).…”