Abstract
Hypopharyngeal squamous-cell carcinoma (HSCC) is a relatively rare head and neck cancer, with great variation in patient outcomes. This study aimed to develop a prognostic nomogram for patients with HSCC. From the Surveillance, Epidemiology, and End Results (SEER) database, we retrieved the clinical data of 2198 patients diagnosed with HSCC between 2010 and 2016. The patients were randomly assigned at a 4:1 ratio to the training set or the validation set. An external validation was performed by a set of 233 patients with locally advanced HSCC treated at our center. A Cox proportional hazards regression model was used to assess the relationship between each variable and overall survival (OS). Cox multivariate regression analysis was performed, and the results were used to develop a prognostic nomogram. The calibration curve and concordance index (C-index) were used to evaluate the accuracy of the prognostic nomogram. With a median overall follow-up time of 41 months (interquartile range: 20 to 61), the median OS for the entire cohort of SEER database was 24 months. The 3-year and 5-year OS rates were 41.3% and 32.5%, respectively. The Cox multivariate regression analysis of the training set showed that age, marital status, race, T stage, N stage, M stage, TNM stage, local treatment, and chemotherapy were correlated with OS. The nomogram showed a superior C-index over TNM stage (training set: 0.718 vs 0.627; validation set: 0.708 vs 0.598; external validation set: 0.709 vs 0.597), and the calibration curve showed a high level of concordance between the predicted OS and the actual OS. The nomogram provides a relatively accurate and applicable prediction of the survival outcome of patients with HSCC.
Highlights
Hypopharyngeal carcinoma is relatively rare and accounts for only approximately 3% of all head and neck tumors [1, 2]
As shown in previous reports, this study reported that race, marital status, and insurance status were related to the overall survival (OS) of Hypopharyngeal squamous-cell carcinoma (HSCC) patients (Figures 2B–D), which to some extent reflected the effects of economic condition, social status, and emotional support on disease prognosis [16, 17]
Our data demonstrated that chemotherapy significantly reduced mortality (HR 0.489, 95% CI 0.416-0.564, P < 0.001) (Table 1 and Figure 2L), and this effect was even more pronounced in patients with locally advanced HSCC with stages T3 and T4 disease (Figure 3D)
Summary
Hypopharyngeal carcinoma is relatively rare and accounts for only approximately 3% of all head and neck tumors [1, 2]. Hypopharyngeal squamous-cell carcinoma (HSCC) is often occult with atypical early symptoms due to its anatomical features, and approximately 80% of patients are already in stage III-IV at diagnosis [2, 3]. A population cohort study of 2939 patients with hypopharyngeal carcinoma showed that 10.5% of patients were in tumor-node-metastasis (TNM) stage I, 12.1% were in stage II, 23.0% were in stage III, and 52.6% were in stage IV at diagnosis, with great variation in patient outcomes [3]. The 5-year overall cancer-specific survival (CSS) rate is 33.4%, while the rate is 63.1% for stage I, 57.5% for stage II, 41.8% for stage III, and 22% for stage IV [3]. There is a lack of prognostic scoring systems that take those above clinical factors into account
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