Survival Determinants in Temporal Bone Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.

Background/Objectives: Temporal bone squamous cell carcinoma (TBSCC) is a rare and aggressive malignancy with limited evidence regarding prognostic factors. This systematic review and meta-analysis evaluated the prognostic significance of tumor stage, cervical nodal status, and surgical margin status in patients with TBSCC. Methods: A systematic search of PubMed and Scopus was conducted from database inception to December 29, 2025, in accordance with the PRISMA 2020 statement. Studies reporting hazard ratios (HRs) for overall survival in patients with TBSCC staged according to the modified Pittsburgh classification were included. Pooled HRs were calculated using random-effects models. Results: Thirteen retrospective cohort studies including 801 patients were analyzed. Positive surgical margins were associated with the greatest increase in mortality risk (HR, 4.79, 95% CI, 2.35-9.75; p < 0.001), followed by cervical nodal metastasis (HR, 2.81; 95% CI, 1.72-4.60; p < 0.001) and advanced tumor stage (T3-T4 vs. T1-T2; HR, 2.39; 95% CI, 1.24-4.60; p = 0.009). Sensitivity analyses confirmed the robustness of the pooled estimates. Conclusions: Positive surgical margins, advanced tumor stage, and cervical nodal metastasis were all significantly associated with poorer survival, with positive surgical margins showing the largest pooled association with mortality among the three evaluated factors. Prospective multicenter studies are needed to validate these findings and improve prognostic stratification in this rare malignancy.