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Comparative Study
. 2020 May 1;18(1):82.
doi: 10.1186/s12957-020-01866-z.

Treatment patterns and survival outcomes of advanced hypopharyngeal squamous cell carcinoma

Yao-Te Tsai  1   2   3 , Wen-Cheng Chen  4 , Chih-Yen Chien  5 , Cheng-Ming Hsu  6 , Yi-Chan Lee  7 , Ming-Shao Tsai  6 , Meng-Hung Lin  8 , Chia-Hsuan Lai  4 , Kai-Ping Chang  9   10
Affiliations
Comparative Study

Treatment patterns and survival outcomes of advanced hypopharyngeal squamous cell carcinoma

Yao-Te Tsai et al. World J Surg Oncol. .

Abstract

Background: This study evaluated the treatment outcomes of the primary surgery (PS) or concurrent chemoradiotherapy (CCRT) as the initial treatment for hypopharyngeal squamous cell carcinoma (HPSCC).

Methods: This retrospective cohort study included patients with stages III-IV HPSCC from four tertiary referral centers consecutively enrolled from 2003 to 2012; of them, 213 (32.6%) and 439 (67.4%) had received PS and CCRT as their primary treatments, respectively. The 5-year overall survival (OS) and disease-free survival (DFS) rates were analyzed using the Kaplan-Meier method and Cox regression models.

Results: In patients undergoing PS and CCRT, OS rates were 45.0% and 33.1% (p < 0.001), respectively, and DFS rates were 36.2% and 28.9% (p = 0.003), respectively. In subgroup analysis, in patients with stage IVA HPSCC, PS was associated with higher OS rate (p = 0.002), particularly in those with T4 or N2 classification (p = 0.021 and 0.002, respectively). Multivariate analysis indicated that stage IVA HPSCC, stage IVB HPSCC, and CCRT were independent adverse prognostic factors for OS rate (p = 0.004, < 0.001, and 0.014, respectively). Furthermore, in patients with stage IVA HPSCC aged ≥ 65 years and with N2 classification, CCRT was significantly associated with lower OS rates than was PS (p = 0.027 and 0.010, respectively).

Conclusions: In patients with advanced HPSCC, PS was significantly associated with better prognosis than CCRT. PS could be a favorable primary treatment modality for the management of patients with stage IVA HPSCC, particularly those aged ≥ 65 years and with T4 and N2 classification.

Keywords: Cancer; Head and neck; Hypopharynx; Prognosis; Squamous cell carcinoma.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart. Only patients with stages III–IV HPSCC were enrolled
Fig. 2
Fig. 2
Kaplan–Meier analysis of OS and DFS rates in patients with advanced hypopharyngeal squamous cell carcinoma. a and b Stages III, IVA, and IVB. c and d PS versus CCRT
Fig. 3
Fig. 3
Kaplan–Meier analysis of OS and DFS rates in patients with stages III–IV HPSCC. a and b Stage III patients. c and d Stage IVA patients. e and f Stage IVB patients
Fig. 4
Fig. 4
Kaplan–Meier analysis of OS rates in patients with stage IVA HPSCC. a Age < 65 years. b Age ≥ 65 years. c T1–T3 classification. d T4 classification. e N0–N1 classification. f N2 classification
Fig. 5
Fig. 5
Kaplan–Meier analysis of DFS rates in patients with stage IVA HPSCC. a Age < 65 years. b Age ≥ 65 years old. c T1–T3 classification. d T4 classification. e N0–N1 classification. f N2 classification
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