Predicting Factors for Oncological and Functional Outcome in Hypopharyngeal Cancer

Abstract

Objectives/Hypothesis Hypopharyngeal squamous cell carcinoma (SCC) is a rare but aggressive malignancy, with low survival rates and high incidence of tumor and treatment‐related morbidity. This study aims to analyze the long‐term oncologic and functional outcomes of a large cohort of patients and to determine prognostic factors. Study Design Retrospective cohort study. Methods The records of all patients diagnosed with hypopharyngeal SCC and treated with curative intent at our tertiary referral center were reviewed. Patient and initial disease characteristics, features, and complications of primary treatment, recurrence patterns, and corresponding treatments and the oncologic and functional long‐term outcome were determined. Results For a total of 179 patients, primary radiotherapy (RT) was the predominant treatment modality (78%), whereas 22% underwent primary surgery. The median, 2‐year, and 5‐year overall survival (OS) for the study cohort were 47 months, 64% and 43%. The median survival after first and second relapse was 7 and 6 months, respectively. The 2 and 5‐year relapse‐free survival (RFS) was 52% and 36%. The median RFS after first relapse and salvage treatment was 9 months. A nodal status of ≥cN2 (HR = 1.89, CI:1.21–3.05, P < .005) and any other primary tumor localization than pyriform sinus (HR = 1.60, CI: 1.04–2.42, P < .05) were identified as independent risk factors for shorter OS and RFS. Regarding functional outcome, the 2‐ and 5‐year laryngectomy‐free‐survival was 55% and 37%, respectively. Conclusions In this large cohort with long‐term follow‐up, any other primary tumor localization than pyriform sinus and a nodal status of ≥cN2 were identified as risk factors for reduced OS and RFS. Level of Evidence 4 Laryngoscope, 131:E1543–E1549, 2021

High Pretreatment LDH Predicts Poor Prognosis in Hypopharyngeal Cancer

“…high, p = 0.009; HR = 0.516, 95% CI 0.313–0.848). Besides, multivariate analysis also disclosed that N2–3 and age ≥60 were correlated with worse prognosis, and these results were consistent with previous study ( 15 , 48 , 49 ). Based on the findings above, patients with high LDH, N2–3 and age ≥60 tend to experience worse survival outcomes, and this group of patients may need to adopt more intensive follow-up care.…”

Evaluation of the prevalence of metachronous second primary malignancies in hypopharyngeal carcinoma and their effect on outcomes

“…Our finding differs from those of some studies, 3,19 but is consistent with Bugter's study, in which 5‐year OS rate was 46.8% in patients with metachronous multiple primary tumors 10 . This may be because of 1), the median interval between the Met‐SPMs and index tumor was 29.3 months (IQR 22.0–47.3), the long control time of the index tumor facilitated metachronous second primary malignancies development, patients without second primary malignancies had a high risk of locoregional failure within 2 years, with a 2‐year OS rate of only 40–60% 21–23 . More than half of metachronous second primary malignancies (52.5%) were in early stage due to our regular follow‐up, which is easy to treat and so far not influence the prognosis of index tumor.…”

Tumour microbiota structure predicts hypopharyngeal carcinoma recurrence and metastasis

“…Unfortunately, there is no stable prediction model. Clinicopathological characteristics currently used as prognostic indicators in clinical practice lack uniform standards and are insufficient to accurately predict the oncologic outcomes [ 7 , 8 ]. New biomarkers may provide more accurate risk stratification of recurrence and metastasis than clinicopathological characteristics and allow more sensitive disease monitoring.…”