Skip to main content

Advertisement

SpringerLink
Log in

Long-term analysis of prognostic risk factors impacting surgical outcomes in patients with external auditory canal carcinoma

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Background

Malignant neoplasms of the external auditory canal (EAC) are rare. No consensus on management has emerged.

Objective

To determine possible risk factors influencing tumorgenesis and prognosis of EAC carcinoma.

Materials and methods

108 patients (87 men/21 women) with an average age of 74 ± 13.8 years were recruited from 2005 to 2019 at Department of Otorhinolaryngology, Head and Neck Surgery Heidelberg. The follow-up interval was 43.62 ± 55.39 months. Partial and (sub)total ablative otis, supplementary surgery (petrosectomy, parotidectomy, neck dissection, mastoidectomy) and adjuvant radio(chemo)therapy belonged to treatment options. TNM status was determined at time of diagnosis using the AJCC staging system.

Results

63.9% of patients underwent a total ablative otis. Tumor recurrence was seen in 24.1%. The 1-year survival rate was 87%, the 5-year survival rate was 52%, the mean overall survival (OS) was 3.82 ± 4.6 years. Male EAC carcinoma patients had a better OS (p < 0.001), PFS (p < 0.001) and DSS (p = 0.02) than females. T1 patients had a better OS (p = 0.01), PFS (p = 0.01) and DSS (p < 0.001) than T4 patients. Lymph node but not distant metastasis, tumor grading, perineural, venous and lymphatic invasion, histology, age and tumor localization influenced the OS in EAC carcinoma patients (p = 0.04). The more radical the ablative otis, the worse the OS (p = 0.002), PFS (p = 0.02) and DSS (p < 0.001). Radio(chemo)therapy did not improve the OS.

Conclusions

EAC carcinoma are difficult to treat and benefit from early diagnosis so that a radical combined treatment approach does not need to be used.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Carvalho CP, Barcellos AN, Teixeira DC, de Oliveira SJ, da Silva NR (2008) Adenoid cystic carcinoma of the external auditory canal. Braz J Otorhinolaryngol 74(5):794–796. https://doi.org/10.1016/S1808-8694(15)31394-X

    Article  PubMed  Google Scholar 

  2. Chang CH, Shu MT, Lee JC, Leu YS, Chen YC, Lee KS (2009) Treatments and outcomes of malignant tumors of external auditory canal. Am J Otolaryngol 30(1):44–48. https://doi.org/10.1016/j.amjoto.2008.02.007

    Article  PubMed  Google Scholar 

  3. Lobo D, Llorente JL, Suarez C (2008) Squamous cell carcinoma of the external auditory canal. Skull Base 18(3):167–172. https://doi.org/10.1055/s-2007-994290

    Article  PubMed  PubMed Central  Google Scholar 

  4. Allanson BM, Low T-H, Clark JR, Gupta R (2018) Squamous cell carcinoma of the external auditory canal and temporal bone: an update. Head Neck Pathol 12(3):407–418. https://doi.org/10.1007/s12105-018-0908-4

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gandhi AK, Roy S, Biswas A, Raza MW, Saxena T, Bhasker S, Sharma A, Thakar A, Mohanti BK (2016) Treatment of squamous cell carcinoma of external auditory canal: a tertiary cancer centre experience. Auris Nasus Larynx 43(1):45–49. https://doi.org/10.1016/j.anl.2015.06.005

    Article  PubMed  Google Scholar 

  6. Lobo D, Llorente JL, Suárez C (2008) Squamous cell carcinoma of the external auditory canal. Skull Base 18(3):167–172. https://doi.org/10.1055/s-2007-994290

    Article  PubMed  PubMed Central  Google Scholar 

  7. Morita S, Mizumachi T, Nakamaru Y, Sakashita T, Kano S, Hoshino K, Fukuda A, Fujiwara K, Homma A (2018) Comparison of the University of Pittsburgh staging system and the eighth edition of the American Joint Committee on Cancer TNM classification for the prognostic evaluation of external auditory canal cancer. Int J Clin Oncol 23 (6):1029–1037. https://doi.org/10.1007/s10147-018-1314-3

  8. Zhang T, Dai C, Wang Z (2013) The misdiagnosis of external auditory canal carcinoma. Eur Arch Otorhinolaryngol 270(5):1607–1613. https://doi.org/10.1007/s00405-012-2159-4

    Article  PubMed  Google Scholar 

  9. Park JM, Kong JS, Chang KH, Jun BC, Jeon EJ, Park SY, Park SN, Park KH (2018) The clinical characteristics and surgical outcomes of carcinoma of the external auditory canal: a multicenter study. J Int Adv Otol 14(2):278–284. https://doi.org/10.5152/iao.2018.4952

    Article  PubMed  PubMed Central  Google Scholar 

  10. Prasad S, Janecka IP (1994) Efficacy of surgical treatments for squamous cell carcinoma of the temporal bone: a literature review. Otolaryngol Head Neck Surg 110(3):270–280. https://doi.org/10.1177/019459989411000303

    Article  CAS  PubMed  Google Scholar 

  11. Wanner B, Rismiller K, Carr DR (2022) Treatment and survival outcomes of ceruminous carcinomas of the external auditory canal: a SEER database analysis and literature review. Arch Dermatol Res 314(6):583–591. https://doi.org/10.1007/s00403-021-02257-4

    Article  PubMed  Google Scholar 

  12. Mazzoni A, Danesi G, Zanoletti E (2014) Primary squamous cell carcinoma of the external auditory canal: surgical treatment and long-term outcomes. Acta otorhinolaryngologica Italica: organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale 34(2):129–137

    CAS  PubMed  Google Scholar 

  13. Schwager K, Pfreundner L Fau - Hoppe F, Hoppe F Fau - Baier G, Baier G Fau - Willner J, Willner J Fau - Baier K, Baier K [Carcinoma of the external ear canal and middle ear as interdisciplinary challenge for ear surgery and radiotherapy] (Das Karzinom des äusseren Gehörgangs und des Mittelohres als interdisziplinäre Herausforderung für Otochirurgie und Strahlentherapie.). (0935–8943 (Print))

  14. Ostrowski VB, Wiet RJ (1996) Pathologic conditions of the external ear and auditory canal. Postgrad Med 100 (3):223–228, 233–227. https://doi.org/10.3810/pgm.1996.09.79

  15. Visnyei K, Gill R, Azizi E, Culliney B (2013) Squamous cell carcinoma of the external auditory canal: a case report and review of the literature. Oncol Lett 5(5):1587–1590. https://doi.org/10.3892/ol.2013.1241

    Article  PubMed  PubMed Central  Google Scholar 

  16. Smit CF, de Boer N, Lissenberg-Witte BI, Merkus P, Hensen EF, Leemans CR (2021) Surgical treatment for squamous cell carcinoma of the temporal bone: predictors of survival. Acta otorhinolaryngologica Italica: organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale 41(4):308–316. https://doi.org/10.14639/0392-100X-N1074

    Article  PubMed  Google Scholar 

  17. Shinomiya H, Uehara N, Teshima M, Kakigi A, Otsuki N, Nibu KI (2019) Clinical management for T1 and T2 external auditory canal cancer. Auris Nasus Larynx 46(5):785–789. https://doi.org/10.1016/j.anl.2019.02.004

    Article  PubMed  Google Scholar 

  18. Prabhu R, Hinerman RW, Indelicato DJ, Morris CG, Werning JW, Vaysberg M, Amdur RJ, Kirwan J, Mendenhall WM (2009) Squamous cell carcinoma of the external auditory canal: long-term clinical outcomes using surgery and external-beam radiotherapy. Am J Clin Oncol 32(4):401–404. https://doi.org/10.1097/COC.0b013e31818f2d48

    Article  PubMed  Google Scholar 

  19. Fleiner F, Jumah M, Göktas O (2009) Cancer of the external auditory canal-diagnostic and treatment. Indian J Otolaryngol Head Neck Surg 61(4):270–274. https://doi.org/10.1007/s12070-009-0081-x

    Article  PubMed  Google Scholar 

  20. Madsen AR, Gundgaard MG, Hoff CM, Maare C, Holmboe P, Knap M, Thomsen LL, Buchwald C, Hansen HS, Bretlau P, Grau C (2008) Cancer of the external auditory canal and middle ear in Denmark from 1992 to 2001. Head Neck 30(10):1332–1338. https://doi.org/10.1002/hed.20877

    Article  PubMed  Google Scholar 

  21. Correia-Rodrigues PA-O, Ramalho S, Montalvão P, Magalhães M External auditory canal carcinoma: clinical characteristics and long-term treatment outcomes. (1434–4726 (Electronic))

  22. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP (2017) The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin 67 (2):93–99. https://doi.org/10.3322/caac.21388

  23. Work G, Invited R, Kim JYS, Kozlow JH, Mittal B, Moyer J, Olencki T, Rodgers P (2018) Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol 78(3):540–559. https://doi.org/10.1016/j.jaad.2017.10.006

    Article  Google Scholar 

  24. Nam GS, Moon IS, Kim JH, Kim SH, Choi JY, Son EJ (2018) Prognostic factors affecting surgical outcomes in squamous cell carcinoma of external auditory canal. Clin Exp Otorhinolaryngol 11(4):259–266. https://doi.org/10.21053/ceo.2017.01340

    Article  PubMed  PubMed Central  Google Scholar 

  25. Arriaga M, Curtin H, Takahashi H, Hirsch BE, Kamerer DB (1990) Staging proposal for external auditory meatus carcinoma based on preoperative clinical examination and computed tomography findings. Ann Otol Rhinol Laryngol 99(9 Pt 1):714–721. https://doi.org/10.1177/000348949009900909

    Article  CAS  PubMed  Google Scholar 

  26. Moody SA, Hirsch BE, Myers EN (2000) Squamous cell carcinoma of the external auditory canal: an evaluation of a staging system. Am J Otol 21(4):582–588

    CAS  PubMed  Google Scholar 

  27. Lassig AA, Spector ME, Soliman S, El-Kashlan HK (2013) Squamous cell carcinoma involving the temporal bone: lateral temporal bone resection as primary intervention. Otol Neurotol 34(1):141–150. https://doi.org/10.1097/MAO.0b013e318278bf38

    Article  PubMed  Google Scholar 

  28. Ihler F, Koopmann M, Weiss BG, Droge LH, Durisin M, Christiansen H, Weiss D, Canis M, Wolff HA (2015) Surgical margins and oncologic results after carcinoma of the external auditory canal. Laryngoscope 125(9):2107–2112. https://doi.org/10.1002/lary.25381

    Article  PubMed  Google Scholar 

  29. Wang Z, Zheng M, Xia S (2016) The contribution of CT and MRI in staging, treatment planning and prognosis prediction of malignant tumors of external auditory canal. Clin Imaging 40(6):1262–1268. https://doi.org/10.1016/j.clinimag.2016.08.020

    Article  PubMed  Google Scholar 

  30. Leong SC, Youssef A, Lesser TH (2013) Squamous cell carcinoma of the temporal bone: outcomes of radical surgery and postoperative radiotherapy. Laryngoscope 123(10):2442–2448. https://doi.org/10.1002/lary.24063

    Article  PubMed  Google Scholar 

  31. Mazzoni A, Danesi G, Zanoletti E (2014) Primary squamous cell carcinoma of the external auditory canal: surgical treatment and long-term outcomes. Acta Otorhinolaryngol Ital 34(2):129–137

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Essig GF, Kitipornchai L, Adams F, Zarate D, Gandhi M, Porceddu S, Panizza B (2013) Lateral temporal bone resection in advanced cutaneous squamous cell carcinoma: report of 35 patients. J Neurol Surg B Skull Base 74(1):54–59. https://doi.org/10.1055/s-0032-1331021

    Article  PubMed  Google Scholar 

  33. Breen JT, Roberts DB, Gidley PW (2018) Basal cell carcinoma of the temporal bone and external auditory canal. Laryngoscope 128(6):1425–1430. https://doi.org/10.1002/lary.26785

    Article  PubMed  Google Scholar 

  34. Hahn SS, Kim JA, Goodchild N, Constable WC (1983) Carcinoma of the middle ear and external auditory canal. Int J Radiat Oncol Biol Phys 9(7):1003–1007. https://doi.org/10.1016/0360-3016(83)90388-7

    Article  CAS  PubMed  Google Scholar 

  35. Oya R, Takenaka Y, Takemura K, Ashida N, Shimizu K, Kitamura T, Yamamoto Y, Uno A (2017) Surgery with or without postoperative radiation therapy for early-stage external auditory canal squamous cell carcinoma: a meta-analysis. Otol Neurotol 38(9):1333–1338. https://doi.org/10.1097/MAO.0000000000001533

    Article  PubMed  Google Scholar 

  36. Shih L, Crabtree JA (1990) Carcinoma of the external auditory canal: an update. Laryngoscope 100(11):1215–1218. https://doi.org/10.1288/00005537-199011000-00016

    Article  CAS  PubMed  Google Scholar 

  37. Nyrop M, Grontved A (2002) Cancer of the external auditory canal. Arch Otolaryngol Head Neck Surg 128(7):834–837. https://doi.org/10.1001/archotol.128.7.834

    Article  PubMed  Google Scholar 

  38. Nakagawa T, Kumamoto Y, Natori Y, Shiratsuchi H, Toh S, Kakazu Y, Shibata S, Nakashima T, Komune S (2006) Squamous cell carcinoma of the external auditory canal and middle ear: an operation combined with preoperative chemoradiotherapy and a free surgical margin. Otol Neurotol 27 (2):242–248; discussion 249. https://doi.org/10.1097/01.mao.0000190463.88873.3d

  39. Takenaka Y, Cho H, Nakahara S, Yamamoto Y, Yasui T, Inohara H (2015) Chemoradiation therapy for squamous cell carcinoma of the external auditory canal: a meta-analysis. Head Neck 37(7):1073–1080. https://doi.org/10.1002/hed.23698

    Article  PubMed  Google Scholar 

  40. Boamah H, Knight G, Taylor J, Palka K, Ballard B (2011) Squamous cell carcinoma of the external auditory canal: a case report. Case Rep Otolaryngol 2011:615210. https://doi.org/10.1155/2011/615210

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No external/additional funding was received for this study. No financial support or funding.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Vera Lohnherr, Niklas Wurzrainer, Jochen Hess, Karim Zaoui & Michaela Plath

  2. GESIS-Leibniz-Institute for the Social Sciences, Mannheim, Germany

    Matthias Sand

  3. Department of Otorhinolaryngology, Head and Neck Surgery, Westpfalz Clinic, Kaiserslautern, Germany

    Philippe Federspil

  4. Molecular Mechanisms of Head and Neck Tumors, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Jochen Hess

Authors
  1. Vera Lohnherr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Niklas Wurzrainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthias Sand
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Philippe Federspil
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jochen Hess
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Karim Zaoui
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michaela Plath
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors made substantial contributions to the study. VL: participated in data acquisition and analysis, interpreted the data, and drafted the manuscript. NW: designed and coordinated the study. MS: participated in data interpretation and statistical analysis. PF: interpreted data and revised the manuscript. KZ: designed and coordinated the study and revised the manuscript. MP: designed and coordinated the study, participated in data acquisition and analysis, and critically revised the manuscript for important intellectual content.

Corresponding author

Correspondence to Michaela Plath.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

The Ethics Committee of the Medical Faculty at the University of Heidelberg granted permission to conduct the study (Project No. S-338/2021).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lohnherr, V., Wurzrainer, N., Sand, M. et al. Long-term analysis of prognostic risk factors impacting surgical outcomes in patients with external auditory canal carcinoma. Eur Arch Otorhinolaryngol 280, 2965–2974 (2023). https://doi.org/10.1007/s00405-023-07890-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-023-07890-5

Keywords

Search

Navigation