目的:系统回顾文献,了解行为,诊断,管理,和外耳道(EAC)转移的死亡率。
■PubMed/Medline,EMBASE,Web的科学。
方法:包括1948年至2023年6月描述EAC转移的研究。非英语文献被排除在外。数据提取:研究设计,年龄,性别,病理学,主站点,分期,其他转移部位,从诊断到EAC转移的时间,从诊断EAC转移到死亡的时间,症状,检查和成像发现,和管理。
结果:定性合成数据,计算平均值。32项研究符合标准,共37例EAC转移患者。平均年龄58岁,73%为男性。最常见的病理是腺癌(37.8%),急性骨髓性白血病(8.1%),肾细胞癌(8.1%)。原发恶性肿瘤部位为血液学(10.8%),乳房(8.1%),食道(8.1%),肾(8.1%),和前列腺(8.1%)。颞骨内,73%的人发生了孤立的EAC转移。从诊断为原发性恶性肿瘤到EAC转移的中位时间为18个月。在21.6%的患者中,EAC的转移是恶性肿瘤的首次表现。中位死亡时间为4.5个月。症状包括听力损失(59.5%),耳痛(27.0%),出血(24.3%),面瘫(21.6%),耳漏(16.2%),和听觉丰满度(13.5%)。在成像方面,50%的病例存在骨侵蚀。治疗主要是姑息性切除和放疗。
结论:EAC转移的表现与其他颞骨亚位点不同。早期活检以建立诊断和干预至关重要。
OBJECTIVE: To systematically review the literature and understand the behavior, diagnosis, management, and mortality of metastasis to the external auditory canal (EAC).
UNASSIGNED: PubMed/Medline, EMBASE, Web of Science.
METHODS: Studies from 1948 to June 2023 describing metastasis to the EAC were included. Non-English literature was excluded. Data extraction: Study design, age, sex, pathology, primary site, staging, additional sites of metastasis, time to EAC metastasis from diagnosis, time from diagnosis of EAC metastasis to death, symptoms, exam and imaging findings, and management.
RESULTS: Data were synthesized qualitatively with means calculated. Thirty-two studies met the criteria, totaling 37 patients with EAC metastasis. Mean age was 58 years; 73% were male. The most common pathologies were adenocarcinoma (37.8%), acute myelogenous leukemia (8.1%), and renal cell carcinoma (8.1%). Sites of primary malignancy were hematologic (10.8%), breast (8.1%), esophagus (8.1%), renal (8.1%), and prostate (8.1%). Within the temporal bone, 73% had isolated EAC metastasis. Median time to EAC metastasis from the diagnosis of primary malignancy was 18 months. Metastasis to the EAC was the first presentation of malignancy in 21.6% of patients. Median time to death was 4.5 months. Symptoms included hearing loss (59.5%), otalgia (27.0%), otorrhagia (24.3%), facial paralysis (21.6%), otorrhea (16.2%), and aural fullness (13.5%). On imaging, bony erosion was present in 50% of cases. Treatment was primarily palliative with excision and radiation.
CONCLUSIONS: EAC metastasis has a distinct presentation from other temporal bone subsites. Early biopsy to establish a diagnosis and intervene is critical.