Abstract
BackgroundThe purpose of this study was to determine prognostic factors influencing outcomes of surgical treatment in patients with T4a hypopharyngeal cancer.MethodsThe present study enrolled 93 patients diagnosed with T4a hypopharyngeal cancer who underwent primary surgery between January 2005 and December 2015 at six medical centers in Korea. Primary tumor sites included pyriform sinus in 71 patients, posterior pharyngeal wall in 14 patients, and postcricoid region in 8 patients. Seventy-two patients received postoperative radio(chemo)therapy.ResultsFive-year disease-free survival (DFS) and disease-specific survival (DSS) rates were 38% and 45%, respectively. In univariate analysis, 5-year DFS was found to have significant and positive correlations with margin involvement (p < 0.001) and extracapsular spread (p = 0.025). Multivariate analysis confirmed that margin involvement (hazard ratio (HR): 2.81; 95% confidence interval (CI): 1.49-5.30; p = 0.001) and extracapsular spread (HR: 2.08; 95% CI: 1.08-3.99; p = 0.028) were significant factors associated with 5-year DFS. In univariate analysis, cervical lymph node metastasis (p = 0.048), lymphovascular invasion (p = 0.041), extracapsular spread (p = 0.015), and esophageal invasion (p = 0.033) were significant factors associated with 5-year DSS. In multivariate analysis, extracapsular spread (HR: 2.98; 95% CI: 1.39-6.42; p = 0.005) and esophageal invasion (HR: 2.87; 95% CI: 1.38-5.98; p = 0.005) remained significant factors associated with 5-year DSS.ConclusionMargin involvement and extracapsular spread are factors influencing recurrence while extracapsular spread and esophageal invasion are factors affecting survival in patients with T4a hypopharyngeal cancer treated by primary surgery.
Highlights
The purpose of this study was to determine prognostic factors influencing outcomes of surgical treatment in patients with T4a hypopharyngeal cancer
Total laryngectomy with partial pharyngectomy was performed in 41 patients, while
Extracapsular spread (HR: 2.98; 95% confidence interval (CI): 1.396.42; p = 0.005) and esophageal invasion (HR: 2.87; 95% CI: 1.38-5.98; p = 0.005) remained significant factors associated with 5-year disease-specific survival (DSS)
Summary
The purpose of this study was to determine prognostic factors influencing outcomes of surgical treatment in patients with T4a hypopharyngeal cancer. Hypopharyngeal cancer represents approximately 7% of all cancers of the upper aerodigestive tract. More than 95% of these cancers are squamous cell carcinomas [1]. Among head and neck cancers, hypopharyngeal squamous cell carcinoma (HPSCC) is known to have the worst prognosis. Some authors advocate for the use of primary radiotherapy alone or in combination with chemotherapy for HPSCC [3,4,5,6]. Treatment of T4a HPSCC continues to fuel debate. Because HPSCC is a relatively rare disease, optimal initial treatment for T4a HPSCC has not been evaluated in any large, prospective, randomized study. Patients exhibiting cartilage invasion have poorer survival
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