Original Article
Treatment outcomes of locally advanced hypopharyngeal squamous cell carcinoma
Abstract
Background: The primary treatment for advanced-stage (stage III–IVB) hypopharyngeal squamous cell carcinoma (HPSCC) includes primary surgery followed by either adjuvant radiotherapy (RT) or adjuvant chemo-radiotherapy (CCRT) or definitive CCRT. However, the optimal primary treatment for advanced HPSCC remains controversial. In the present study, we intend to compare the outcome of primary surgery versus definitive CCRT and try to identify the optimal treatment for advanced-stage hypopharyngeal cancer.
Methods: We performed a retrospective analysis of newly diagnosed patients with stage III, IVA and IVB HPSCC at the southern branches (Chiayi and Kaohsiung) of Chang Gung Memorial Hospital between September 2002 and September 2013. The 5-year overall survival (OS), disease-free survival (DFS), loco-regional recurrence rate (LRR) and distant-metastasis rate (DMR) were analyzed and compared between primary surgery and definitive CCRT groups.
Results: We enrolled 367 consecutive patients in this retrospective study. 110 patients who did not meet the study's criteria were excluded from analysis. Among the 257 patients included, 133 patients were treated with primary surgery (the SX group) and 124 patients were treated with definitive CCRT (the CCRT group). With a median follow-up time of 5.83 years for surviving patients, the 5-year OS (53% vs. 32%, P<0.001), and DFS (48% vs. 28%, P<0.001) were significantly higher in the SX group than the CCRT group. The 5-year LRR (28% for SX group vs. 53% for CCRT group, P<0.001) was significantly lower in the SX group. The 5-year distant metastasis rates (21% for SX group vs. 25% for CCRT group, P=0.276) were comparable between these 2 groups. Multivariate Cox regression analysis revealed that primary treatment with surgery improved OS [hazard ratio (HR), 0.55; 95% CI, 0.35–0.86; P=0.008], DFS (HR, 0.52; 95% CI, 0.34–0.79; P=0.002) and decreased LRR (HR, 0.37; 95% CI, 0.21–0.63; P<0.001).
Conclusions: Among patients with advanced stage HPSCC (stage III, IVA and IVB), primary radical surgery has significant better overall, DFS and loco-regional control rates than primary CCRT. However, due to the limited sample size and retrospective nature of this study, further larger or prospective studies are still needed to identify patients with advanced hypopharyngeal cancer suitable for primary CCRT or organ preservation treatment.
Methods: We performed a retrospective analysis of newly diagnosed patients with stage III, IVA and IVB HPSCC at the southern branches (Chiayi and Kaohsiung) of Chang Gung Memorial Hospital between September 2002 and September 2013. The 5-year overall survival (OS), disease-free survival (DFS), loco-regional recurrence rate (LRR) and distant-metastasis rate (DMR) were analyzed and compared between primary surgery and definitive CCRT groups.
Results: We enrolled 367 consecutive patients in this retrospective study. 110 patients who did not meet the study's criteria were excluded from analysis. Among the 257 patients included, 133 patients were treated with primary surgery (the SX group) and 124 patients were treated with definitive CCRT (the CCRT group). With a median follow-up time of 5.83 years for surviving patients, the 5-year OS (53% vs. 32%, P<0.001), and DFS (48% vs. 28%, P<0.001) were significantly higher in the SX group than the CCRT group. The 5-year LRR (28% for SX group vs. 53% for CCRT group, P<0.001) was significantly lower in the SX group. The 5-year distant metastasis rates (21% for SX group vs. 25% for CCRT group, P=0.276) were comparable between these 2 groups. Multivariate Cox regression analysis revealed that primary treatment with surgery improved OS [hazard ratio (HR), 0.55; 95% CI, 0.35–0.86; P=0.008], DFS (HR, 0.52; 95% CI, 0.34–0.79; P=0.002) and decreased LRR (HR, 0.37; 95% CI, 0.21–0.63; P<0.001).
Conclusions: Among patients with advanced stage HPSCC (stage III, IVA and IVB), primary radical surgery has significant better overall, DFS and loco-regional control rates than primary CCRT. However, due to the limited sample size and retrospective nature of this study, further larger or prospective studies are still needed to identify patients with advanced hypopharyngeal cancer suitable for primary CCRT or organ preservation treatment.
