Abstract
Objectives:
Middle ear cancer is a rare condition with limited data regarding incidence and outcomes. We used the National Cancer Data Base (NCDB) to describe the patient characteristics, treatment patterns, and outcomes of these uncommon malignancies.
Methods:
A total of 458 cancers coded as having the middle ear as their primary site were selected from the NCDB between 1998 and 2011 and analyzed using chi-square tests and Cox regression.
Results:
Median age at diagnosis was 64 years (range, 18-90 years) and most patients were white (79.7%). Histologic subtypes included squamous cell carcinoma (57.8%), adenocarcinoma (12.7%), other carcinoma (15.3%), and non-carcinoma (14.2%). Of the 209 patients with documented tumor extension, 38.8%, 55.5%, and 5.7% had local, regional, and distant disease, respectively. Treatment included surgery alone (41.3%), surgery and adjuvant therapy (40.9%), and nonsurgical therapy alone (17.8%). In patients from 1998-2006 with local and regional disease, the 5-year survival rates were 52%, 27%, and 22% for these treatment groups, respectively. After risk-adjustment, surgery alone had better survival compared with surgery and adjuvant therapy (hazard ratio [HR] =1.66, 95% confidence interval [CI] = 1.01, 2.73, P = .045). Although not statistically significant, nonsurgical therapy trended toward worse survival (HR = 1.66, 95% CI = 0.95, 2.91, P = .075).
Conclusions:
Patients with local and regional disease treated with surgery alone have the best survival, perhaps because of localized disease originating in the external auditory canal with minimal extension into the middle ear. Although the cases may be originating within the temporal bone, the true site of origin for middle ear cancers is ambiguous and a stricter coding system is needed.
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