Abstract：Objective This study aims to investigate the survival of patients with locally advanced hypopharyngeal squamous cell carcinoma (HPSCC) and its associated risk factors affecting prognosis. Methods A retrospective cohort study was conducted. The clinical data of 115 patients diagnosed with locally advanced HPSCC in the Department of Otolaryngology Head and Neck Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2013 to December 2018 were included. The patients included 110 males and 5 females aged 42-84 (62.9±9.8) years, with a median age of 64 years. The patients were grouped according to different treatment modalities: 65 cases in the surgical group, with a comprehensive treatment mode based on surgery; and 50 cases in the non-surgical group, with a non-surgical comprehensive treatment mode. The observation indicators were as follows. (1) The complications of the two groups were observed, and the laryngeal function retention rate was compared between the operation and non-operation groups (the optimal laryngeal function evaluation result in the follow-up was the final result); (2) 3-year and 5-year survival rates were analyzed, and Kaplan-Meier method was used to calculate the cumulative survival rate of patients; (3) prognostic factors of patients with locally advanced HPSCC were analyzed by log-rank test, and independent risk factors were analyzed by Cox proportional risk regression model; and (4) patients were further divided according to prognostic independent risk factors: one risk factor was included in the low-risk group, and two or more risk factors were included in the high-risk group. The 5-year cumulative survival rate of patients with different treatment modes in different risk groups was observed and the prognosis was compared. Results (1) No significant differences in baseline data of gender, age, smoking, drinking, anatomical subarea of lesions, tumor stage, and tumor differentiation were found between the operation and non-operation groups (all P values >0.05). Pharyngeal fistula occurred in 4 patients in the operation group, all of which were healed after anti-inflammatory and local long-term dressing change. Three cases of skin flap infection or partial necrosis occurred in the patients undergoing flap repair, all of which were healed after anti-inflammatory, local dressing change, or secondary surgical repair. In the non-operation group, 3 patients with dyspnea received tracheotomy and 2 patients with dysphagia received gastrostomy. The scores of laryngeal function in patients with retention rate was 35.4% (23/65), and the surgical group was 68.0% (34/50); the difference was statistically significant (χ2=12.03, P<0.001). (2) The 3-year and 5-year cumulative survival rates of 115 patients were 47.0% and 39.9%, respectively. The median survival time was 32.0 months. The 3-year and 5-year cumulative survival rates of the surgery group were 56.9% and 50.7%, respectively, while those of the non-surgery group were 34.0% and 25.8%, respectively. (3) Univariate analysis showed that the anatomic subarea of tumor lesion, T stage, N stage, clinical stage, and treatment method were factors influencing the prognosis of patients (all P<0.05). The results of multivariate analysis showed that tumor T3-T4 stage (hazard ratio [HR]=2.729, 95% confidence interval [CI] 1.626-4.581), N+ stage (HR=3.296, 95%CI 1.521-7.144), non-surgical treatment (HR=1.720, 95%CI 1.104-2.680), and retrocyclic/retropharyngeal type (HR=1.736, 95%CI 1.064-2.834) were independent risk factors for prognosis. (4) In the low-risk group, the 5-years cumulative survival rate was 67.2% of patients in the operation group, the non-surgical patients was 48.6%, and the difference was not statistically significant to its survival (χ2=0.21, P=0.647). In the high-risk group, the 5-year cumulative survival rate of surgical patients was 37.5%, the non-surgical patients was 15.4%, its survival difference was statistically significant (χ2=4.54, P=0.033). Conclusion Patients with locally advanced HPSCC have a poor prognosis, with the T3-T4 stage of the tumor, N+ stage, anatomical subzone of the lesion being the posterior cricoid/posterior pharyngeal wall type, and non-surgical treatment as independent risk factors affecting patient prognosis. Non-surgical treatment has a higher rate of preservation of laryngeal function than surgical treatment. The 5-year cumulative survival rate of patients with 2 or 3 risk factors is higher with surgery-based combination therapy compared with non-surgical treatment.
马俊结, 刘耘帆, 王晓敏, 张俊杰, 赵梅君, 蔡常琦, 张瑞静, 徐诗逸, 马士崟. 局部晚期下咽鳞状细胞癌的预后及其影响因素分析[J]. 中华解剖与临床杂志, 2023, 28(9): 598-604.
Ma Junjie, Liu Yunfan, Wang Xiaomin, Zhang Junjie, Zhao Meijun, Cai Changqi, Zhang Ruijing, Xu Shiyi, Ma Shiyin. Prognosis of locally advanced squamous cell carcinoma of the hypopharynx and analysis of its influencing factor. Chinese Journal of Anatomy and Clinics, 2023, 28(9): 598-604.
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2023, Vol. 28 
