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Otol."],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S002221512100089X_sec_a1\"><jats:title>Background<\/jats:title><jats:p>The prognosis of patients with advanced squamous cell carcinoma of the external auditory canal and middle ear has been improved by advances in skull base surgery and multidrug chemoradiotherapy during the last two decades.<\/jats:p><\/jats:sec><jats:sec id=\"S002221512100089X_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>Ninety-five patients with squamous cell carcinoma of the external auditory canal and middle ear who were treated between 1998 and 2017 were enrolled. The number of patients with tumour stages T<jats:sub>1<\/jats:sub>, T<jats:sub>2<\/jats:sub>, T<jats:sub>3<\/jats:sub>and T<jats:sub>4<\/jats:sub>was 15, 22, 24 and 34, respectively. Oncological outcomes and prognostic factors were retrospectively investigated.<\/jats:p><\/jats:sec><jats:sec id=\"S002221512100089X_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Among patients with T<jats:sub>4<\/jats:sub>disease, invasion of the brain (<jats:italic>p<\/jats:italic>= 0.024), carotid artery (<jats:italic>p<\/jats:italic>= 0.049) and\/or jugular vein (<jats:italic>p<\/jats:italic>= 0.040) were significant predictors of poor prognosis. The five-year overall survival rate of patients with at least one of these factors (T<jats:sub>4b<\/jats:sub>) was significantly lower than that of patients without these factors (T<jats:sub>4a<\/jats:sub>) (25.5<jats:italic>vs<\/jats:italic>65.5 per cent,<jats:italic>p<\/jats:italic>= 0.049).<\/jats:p><\/jats:sec><jats:sec id=\"S002221512100089X_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusion<\/jats:title><jats:p>It is proposed that stage T<jats:sub>4<\/jats:sub>be subclassified into T<jats:sub>4a<\/jats:sub>and T<jats:sub>4b<\/jats:sub>according to the prognostic factors.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s002221512100089x","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T04:45:21Z","timestamp":1617165921000},"page":"297-303","source":"Crossref","is-referenced-by-count":17,"title":["New proposal to revise the classification for squamous cell carcinoma of the external auditory canal and middle 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