The Role of Facial Palsy in Staging Squamous Cell Carcinoma of the Temporal Bone and External Auditory Canal: A Comparative Survival Analysis

Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (Impact Factor: 1.79). 10/2010; 31(9):1473-9. DOI: 10.1097/MAO.0b013e3181f7ab85
Source: PubMed


The role for facial palsy in the Pittsburgh staging system for squamous cell carcinoma (SCC) of the external auditory canal (EAC) is unclear. The objective of this study was to conduct a systematic review of published studies to determine the impact of facial palsy on survival outcomes.
A search of MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, Cochrane,, and the National Guideline Clearinghouse databases was supplemented by hand searching.
Articles selected for final analysis had individual subject data on staging and/or facial nerve function, outcome, and follow-up period.
Data extracted included demographics, type and stage of cancer, survival, and facial nerve status.
Of 3,046 citations identified by a systematic literature search, 21 case series including 348 subjects with SCC of the EAC met criteria for analysis. The overall and disease-specific survival for subjects with facial palsy were significantly worse than subjects without facial palsy, regardless of stage (p = 0.006 and p = 0.002, respectively). The overall survival outcome for subjects with facial palsy was significantly worse than subjects with stage PITT-2000 T3-designated cancer (p = 0.027) and demonstrated no statistically significant difference from stage PITT-2000 T4-designated cancer (p = 0.897).
This pooled-data survival analysis for SCC of the EAC demonstrates that facial nerve involvement is associated with a poor outcome and that the survival outcomes for subjects with facial palsy more closely parallel the survival curves of advanced stage T4 disease. Disease with facial palsy should be classified as stage T4, in accordance with the PITT-2000 system.

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    • "Prognostic factors for carcinoma of the EAC are TNM stage, bony erosion of the EAC, positive surgical margins, extratemporal locoregional invasion (parotid, cervical), middle ear involvement and the presence of peripheral facial nerve palsy [6] [7] [21] [24] [31]. In this study, the mean survival of the 20% of patients with peripheral facial nerve palsy at diagnosis was 8.5 months (7 and 10 months, respectively ) versus 28.13 months in the absence of facial nerve palsy. "
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