Abstract
Objectives
Ceruminous adenocarcinoma is a rare malignancy. However, due to the paucity of cases, this has been difficult to study. Using a population-based national database, patient demographics and survival trends were analyzed to further elucidate the management of this malignancy.
Methods
The SEER database was queried for patients diagnosed with ceruminous adenocarcinoma between 1973 and 2010.
Results
Twenty-two patients were identified in the database. The average age of diagnosis was between 60 and 64 years. All of the patients underwent surgical resection of the primary malignancy. Eight patients (36%) also had postoperative radiation.
Conclusions
Ceruminous adenocarcinoma is uncommon but may not have as poor a prognosis as previously thought. Surgical resection alone appears to be a reasonable treatment option. Larger prospective studies are needed, but database analysis like this may provide clarity on the management of uncommon diseases.
1
Introduction
Ceruminous tumors of the external auditory canal (EAC) are rare . Malignant tumors in this location are even more uncommon . These tumors can become a diagnostic dilemma due to their varied etiology and confusing nomenclature . Due to the paucity of data, the treatment and prognosis of these tumors are poorly understood. Using a population-based national database, our objective was to describe patient demographics and survival trends in order to further elucidate the management of ceruminous adenocarcinoma.
The Survival, Epidemiology, and End Results (SEER) Program of the National Cancer Institute is a coordinated effort of cancer registries located across the United States. It currently collects cancer incidence and survival data from 18 geographic regions that represent approximately 26% of the U.S. population .
2
Methods
The SEER database was queried for patients diagnosed with ceruminous adenocarcinoma (Site and Morphology, ICD-O-3 Hist/behave, malignant = 8420/3: Ceruminous adenocarcinoma) between 1973 and 2010. Data collected included patient demographics, treatment modality, and survival.
Patients were divided into two cohorts — those treated with surgical resection alone and those treated with surgical resection followed by postoperative radiation. A Kaplan–Meier survival curve was created in order to compare prognosis between the cohorts. A log-rank p-value was calculated to compare the survival difference between these groups. A proportional hazards model was created to adjust for potential demographic confounders. Statistical significance was set at a p-value < 0.05. This project was reviewed and approved by the Tripler Army Medical Center Institutional Review Board.
2
Methods
The SEER database was queried for patients diagnosed with ceruminous adenocarcinoma (Site and Morphology, ICD-O-3 Hist/behave, malignant = 8420/3: Ceruminous adenocarcinoma) between 1973 and 2010. Data collected included patient demographics, treatment modality, and survival.
Patients were divided into two cohorts — those treated with surgical resection alone and those treated with surgical resection followed by postoperative radiation. A Kaplan–Meier survival curve was created in order to compare prognosis between the cohorts. A log-rank p-value was calculated to compare the survival difference between these groups. A proportional hazards model was created to adjust for potential demographic confounders. Statistical significance was set at a p-value < 0.05. This project was reviewed and approved by the Tripler Army Medical Center Institutional Review Board.
3
Results
Twenty-eight patients were initially identified from the database. Twenty-two patients remained after selecting cases with primary tumors in the external auditory canal. The average age at diagnosis was 60–64 years ( Table 1 ). Staging was unknown for all but four patients ( Table 2 ). All patients underwent surgical resection of the primary malignancy. Eight (36%) also had postoperative radiation. These patients survived fewer months compared to the surgery-alone group ( Fig. 1 ), but this was not statistically significant (p = 0.252). When dichotomized into age < 60 vs. > 60 years, there was a significant decrease in survival with higher age (p = 0.006). There was no significant difference in survival when a proportional model was adjusted for age and radiation effect.
| Total (%) | Surgery (%) | Surgery + Radiation (%) | ||||
|---|---|---|---|---|---|---|
| Gender | ||||||
| Male | 15 | (68.2) | 9 | (64.3) | 6 | (75) |
| Female | 7 | (31.8) | 5 | (35.7) | 2 | (25) |
| Race | ||||||
| White | 15 | (68.2) | 11 | (78.6) | 4 | (50) |
| Black | 3 | (13.6) | 2 | (14.3) | 1 | (12.5) |
| Other | 4 | (18.2) | 1 | (7.1) | 3 | (37.5) |
| Laterality | ||||||
| Right | 10 | (45.5) | 5 | (35.7) | 5 | (62.5) |
| Left | 11 | (50) | 8 | (57.1) | 3 | (37.5) |
| 1 | (4.6) | 1 | (7.1) | 0 | ||
| Age (years) | ||||||
| 25–29 | 1 | (4.6) | 1 | (7.1) | 0 | |
| 30–34 | 0 | 0 | 0 | |||
| 35–39 | 2 | (9.1) | 1 | (7.1) | 1 | (12.5) |
| 40–44 | 1 | (4.6) | 1 | (7.1) | 0 | |
| 45–49 | 0 | 0 | 0 | |||
| 50–54 | 2 | (9.1) | 1 | (7.1) | 1 | (12.5) |
| 55–59 | 1 | (4.6) | 1 | (7.1) | 0 | |
| 60–64 | 4 | (18.2) | 2 | (14.3) | 2 | (25) |
| 65–69 | 1 | (4.6) | 0 | 1 | (12.5) | |
| 70–74 | 5 | (22.7) | 4 | (28.6) | 1 | (12.5) |
| 75–79 | 2 | (9.1) | 1 | (7.1) | 1 | (12.5) |
| 80–84 | 0 | 0 | 0 | |||
| 85 + | 3 | (13.6) | 2 | (14.3) | 1 | (12.5) |
| Survival Average Months | 112.68 | 125.86 | 89.63 | |||
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