{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:52:09Z","timestamp":1786978329247,"version":"build-2736575974"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T00:00:00Z","timestamp":1715731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The purpose of this study was to define an improved staging system for adenoid cystic carcinoma (ACC) in the external auditory canal (EAC) based on biological behaviors, image findings, and the prognosis of patients with ACC in the EAC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>A retrospective study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A single center data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a single\u2010institution retrospective review of 154 patients with ACC in the EAC between January 2004 and September 2021. Risk factors associated with disease\u2010free survival (DFS) and cancer\u2010specific survival (CSS) of ACC in the EAC were identified using univariate and multivariate cox regression analysis. Then an improved staging system was proposed and compared with the Pittsburgh\u2010modified tumor, node, and metastasis (TNM) staging system for statistical differences in DFS and CSS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>An improved staging system of ACC in the EAC was defined, in which stage T4 were subclassified into T4a and T4b and were statistically different from the Pittsburgh\u2010modified TNM staging system in DFS and CSS. We also found that the dura mater, facial nerve, sigmoid sinus, deep lobe of parotid gland, and parapharyngeal space involvement were significantly associated with poor prognosis of ACC in the EAC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The improved staging system is more accurate in predicting survival prognosis than Pittsburgh\u2010modified TNM staging system for patients with ACC in the EAC, and may provide more efficient guidance of treatment strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>The improved staging system of ACC in the EAC is more accurately to predict survival prognosis, and provide guidance of treatment plan than Pittsburgh\u2010modified TNM staging system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>4.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.828","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T01:24:11Z","timestamp":1715822651000},"page":"1083-1091","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["An Improved Staging System of Adenoid Cystic Carcinoma in the External Auditory Canal"],"prefix":"10.1002","volume":"171","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5660-8799","authenticated-orcid":false,"given":"Jing","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, ENT Institute, Eye &amp; ENT Hospital Fudan University Shanghai China"},{"name":"NHC Key Laboratory of Hearing Medicine Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feitian","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, ENT Institute, Eye &amp; ENT Hospital Fudan University Shanghai China"},{"name":"NHC Key Laboratory of Hearing Medicine Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yisi","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, ENT Institute, Eye &amp; ENT Hospital Fudan University Shanghai China"},{"name":"NHC Key Laboratory of Hearing Medicine Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dedi","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, ENT Institute, Eye &amp; ENT Hospital Fudan University Shanghai China"},{"name":"NHC Key Laboratory of Hearing Medicine Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yibo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, ENT Institute, Eye &amp; ENT Hospital Fudan University Shanghai China"},{"name":"NHC Key Laboratory of Hearing Medicine Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6948-7289","authenticated-orcid":false,"given":"Chunfu","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, ENT Institute, Eye &amp; ENT Hospital Fudan University Shanghai China"},{"name":"NHC Key Laboratory of Hearing Medicine Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,15]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-6665(20)30318-2"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/000348949009900909"},{"issue":"4","key":"e_1_2_8_4_1","first-page":"582","article-title":"Squamous cell carcinoma of the external auditory canal: an evaluation of a staging system","volume":"21","author":"Moody SA","year":"2000","journal-title":"Am J Otol"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-40618-3"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.23155"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70178-5"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10147-018-1314-3"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000001152"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e3181f7ab85"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23637"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19821215)50:12<2873::AID-CNCR2820501230>3.0.CO;2-R"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1017\/S002221512100089X"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24400"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.27082"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2021.11.002"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26800"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000001683"},{"key":"e_1_2_8_19_1","first-page":"383","article-title":"Anatomy and orientation of the human external ear","volume":"8","author":"Alvord LS","year":"1997","journal-title":"J Am Acad Audiol"},{"issue":"1","key":"e_1_2_8_20_1","first-page":"1","article-title":"The role of total parotidectomy in high\u2010grade parotid malignancy: a multisurgeon retrospective review","volume":"43","author":"Karp EE","year":"2021","journal-title":"Am J Otolaryngol"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000002391"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24915"},{"key":"e_1_2_8_23_1","doi-asserted-by":"crossref","unstructured":"The National Lung Screening Trial Research Team. 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