11例外耳鳞状细胞癌临床诊治分析

Clinical analysis of 11 cases of squamous cell carcinoma of the external ear

摘要:

目的 通过回顾外耳鳞状细胞癌(SCC)的临床资料，分析该病的复发原因，并总结其临床诊疗经验。方法 收集2020年1月—2024年12月新疆维吾尔自治区人民医院耳鼻喉诊疗中心收治的11例外耳SCC患者的临床资料，根据肿瘤临床表现、分期、既往治疗史，经肿瘤多学科讨论确定最佳治疗方案，随访并评估治疗效果。结果 11例患者中，耳廓皮肤鳞状细胞癌(cSCC)2例，原发性外耳道鳞状细胞癌(EACSCC)3例，耳廓cSCC侵犯外耳道者6例。所有患者均以耳痛为首发症状(100%)，伴耳漏(81.80%)、皮肤溃烂(36.36%)；T2期3例，T3期3例，T4期5例。10例接受手术治疗，手术方式包括外耳恶性肿瘤切除术、颞骨外侧切除术、颞骨次全切除术、联合腮腺切除及皮瓣修复；术后辅助放疗2例，同步放化疗3例(含改良EXTREME方案)。8例累及耳廓的患者中，5例(62.50%)复发，其中4例为术后复发；术后复发患者中切缘阳性者占3例(75.00%)。随访14～46个月，2例因远处转移死亡，1例因脑梗去世，7例带瘤生存，1例无瘤生存。结论 外耳SCC的预后与首次手术实现R0切除密切相关。对于耳廓cSCC，应强调精准的术前评估和根治性切除，莫氏显微描记手术有助于在保证切缘阴性的同时保留功能与外观。晚期患者应采取以手术、放化疗为主的综合治疗策略，新辅助免疫治疗是今后的探索方向。

Abstract:

Objective To analyze the causes of disease recurrence and summarize clinical diagnostic and therapeutic experiences by reviewing the clinical data of external ear squamous cell carcinoma (SCC). Methods A retrospective analysis was conducted on 11 patients with SCC of the external ear treated at the Ear, Nose and Throat Centre of the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2020 to December 2024. Based on clinical manifestations, tumor stage and prior treatment history, optimal treatment plans were formulated through multidisciplinary team discussions. These patients were followed up to evaluate therapeutic outcomes. Results Among the 11 patients, there were 2 cases of cutaneous SCC (cSCC) on the auricle, 3 cases of primary External Auditory Canal Squamous Cell Carcinoma (EACSCC), and 6 cases of auricular cSCC invading the external auditory canal. All patients presented with otalgia as the initial symptom (100%), accompanied by otorrhea (81.80%) and skin ulceration (36.36%). There were 3 cases in stage T2, 3 cases in stage T3, and 5 cases in stage T4. Ten patients underwent surgical treatment, including resection of malignant tumors of the external ear, lateral temporal bone resection, subtotal temporal bone resection, and combined parotidectomy with flap reconstruction. Postoperative adjuvant radiotherapy was administered in 2 cases. Three cases received concurrent chemoradiotherapy (including the modified EXTREME regimen). Of the 8 patients with auricular involvement, 5 cases (62.50%) relapsed, including 4 postoperative recurrences. Among the patients with postoperative recurrence, 3 cases (75.00%) exhibited positive surgical margins. During a follow-up period of 14 to 46 months, two cases of the patients died from distant metastasis, one died from cerebral infarction, seven survived with tumors, and one survived without tumors. Conclusions The prognosis of EACSCC is closely related to achieving R0 resection during the initial surgery. For cSCC of the auricle, precise preoperative evaluation and radical resection are crucial. Mohs micrographic surgery facilitates the preservation of function and appearance while ensuring negative surgical margins. A comprehensive treatment strategy based on surgery and chemoradiotherapy is essential for advanced patients. Neoadjuvant immunotherapy represents a future research direction.