Abstract
IntroductionWe aimed to analyze the relationship between the changed status of vocal cord mobility and survival outcomes.MethodsSeventy-eight patients with dysfunctional vocal cords and hypopharyngeal carcinomas accepted non-surgical treatment as the initial therapy between May 2009 and December 2016. Vocal cord mobility was assessed before and after the initial non-surgical treatment. The cord mobility status was classified as normal, impaired, and fixed. Patients with improved mobility (IM) (n =56) were retrospectively analyzed for disease-free survival (DFS), recurrence-free survival (RFS), and overall survival (OS) and compared with 22 patients with non-improved mobility (non-IM).ResultsFifty-six (71.8%) patients had improved cord mobility after the initial non-surgical treatment. The non-improved cord mobility was significantly associated with shortened DFS (P=0.005), RFS (P=0.002), and OS (P<0.001). If non-improved cord mobility was regarded as an indicator for local-regional recurrence within 1 year, the sensitivity and the specificity were 60.9%, 87.5% respectively. The multivariate analysis showed that improved cord mobility (P=0.006) and salvage surgery (P=0.015) were both independent protective factors for OS.ConclusionChanges in cord mobility are a key marker for predicting prognosis. Non-improved cord mobility may indicate a high possibility of a residual tumor, therefore, patients whose cord mobility remains dysfunctional or worsens after non-surgical treatment might need an aggressive salvage strategy.
Highlights
We aimed to analyze the relationship between the changed status of vocal cord mobility and survival outcomes
The non-improved cord mobility was significantly associated with shortened diseasefree survival (DFS) (P=0.005), recurrence-free survival (RFS) (P=0.002), and overall survival (OS) (P
When the tumor mass was eliminated through non-surgical treatment, patients who experienced vocal cord dysfunction caused by the weight effect had a high possibility of experiencing normal mobility
Summary
We aimed to analyze the relationship between the changed status of vocal cord mobility and survival outcomes. The prognosis of hypopharyngeal squamous cell carcinoma (HPSCC) has improved in the last decade, HPSCC is still associated with the worst survival outcomes among all head and neck cancers. The 5-year survival rate of patients with advanced disease (stages III–IV) ranges from 30 to 54% [1, 2]. Pretreatment vocal cord fixation is a significantly poor prognostic factor in HPSCC. The mobility of the vocal cord might affect the choice of conservative surgery. Salvage surgery still plays an important role in the treatment of advanced HPSCC and relapse, but the proper time for surgical invention and how to select candidates who would benefit from the sacrifice of function for survival purposes remain questionable
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