Survival in Squamous Cell Carcinoma of the Temporal Bone: 1965–2011

Background: Squamous cell carcinoma (SCC) of the temporal bone is an uncommon entity that has a poor prognosis. Tumors may present at an advanced stage given the proximity of the temporal bone to critical structures. We reviewed the literature from 1965 through 2011 to determine factors affecting survival, as well as to determine whether there is a survival advantage for different treatment modalities.

Methods: A meta-analysis was conducted using individual patient data available from papers published from 1965 through 2011. Patient data were collected for overall survival at 3, 5, and 10 years. Only patients with histologically confirmed SCC were included, with other malignancies excluded. Patients were grouped using the University of Pittsburgh staging system, and were also grouped according to treatment modality.

Results: A total of 71 papers and 1355 patients were identified. Overall survival at 3, 5, and 10 years was 47%, 42.3%, and 20.6%, respectively. There was a significant decrease in survival for T3/T4 tumors vs. T1/T2 tumors at 3, 5, and 10 years (69%, 69%, and 34.8% for T1/2 vs. 42.6%, 34.9%, and 10.6% for T3/4, respectively, P < 0.0005). We found a male predominance of 1.3:1 (P = 0.0078). We found the presence of hearing loss, facial nerve paralysis, and parotid involvement to all indicate a significant decrease in survival vs. patients without these clinical signs (P < 0.05). We found a statistically significant survival advantage at 3 years for surgery alone (72.5%) vs. radiotherapy alone (55.7%), P = 0.006.

Conclusions: We present a comprehensive meta-analysis of patients treated for SCC of the temporal bone reported from 1965 through 2011, totaling 1355 patients. Statistically significant survival decreases were seen with involvement of the parotid or facial nerve, as well as with hearing loss on presentation. There was a statistically significant decrease in survival for T3/T4 tumors vs. T1/T2 tumors. Additionally, we found a survival advantage for patients treated with surgery alone vs. patients treated with radiation alone at 3 years. To our knowledge, this represents the largest meta-analysis of patients with SCC of the temporal bone, and provides valuable prognostic and treatment-specific survival data on this uncommon malignancy.