Surgery For Hypopharyngeal Squamous Cell Carcinoma: Analysis Of Treatment Outcome And Prognostic Factors

[Objectives] The purpose of this study is to investigate the clinical characteristics, surgical treatment choices and to define prognostic factors for hypopharyngeal carcinoma,[Methods] A retrospective review of the Eye & ENT Hospital of Fudan University patients’database between January 2003 and June 2013 was conducted and a total number of 386 patients who met the inclusion criteria were enrolled in the study. Patients’basic clinical and oncological information were collected and survival data were analyzed using Kaplan-Meier curves. Outcomes were also compared according to different primary tumor procedures, reconstruction methods and the extent of neck dissections.[Results] Among the 386 patients 95.9% were male and 4.1% were female, with an average age of 58.4±9.4 years. The primary tumor sites were piriform sinus (76.7%), posterior hypopharyngeal wall (17.3%) and postcricoid region (6.0%). There were 31(8.0%),83(21.5%),175(45.3%) and 97(25.1%) patients with stage T1 to T4, respectively, and 99(25.6%),74(19.2%),181(46.9%) and 32(8.3%) patients with stage NO to N3, respectively.3 patients had distant metastasis to lung on initial diagnosis. Second primary cancers were found in 28 cases (7.3%). The 3-year overall survival (OS), disease specific survival (DSS) and disease free survival (DFS) were 51.8%,53.6% and 49.6%, respectively according to Kaplan-Meier survival curves. And 5-year OS, DSS and DFS are 45.8%,48.1% and 46.0% respectively. Multivariate Cox regression model showed significant association between 5-year overall survival rate and advanced T stage (p<0.001), N stage (p=0.003) and second primary tumors (p=0.017). Advanced T stage and lymphovascular invasion are associated with a higher rate of recurrence (p<0.001). As for surgical treatment,82(21.2%),103(26.7%) and 341(88.3%) patients underwent laryngeal preservation surgery, reconstruction and neck dissection. The laryngeal preservation rate is higher among T1-2 tumors, whereas reconstruction surgeries are more prevalent among T3-4 tumors.11.4% and 60.6% of patients received pre-and postoperative adjuvant therapy. Complications occurred in 104(26.9%) patients.5-year OS among patients who received reconstruction with radial forearm free flap, pectoralis major myomucutaneous flap and gastric pull-up are 34.2%,20.9% and 13.7%. There was no significant difference in 5-year survival according to primary tumor resection and neck dissection methods.[Conclusions] Hypopharyngeal squamous cell carcinoma has a dismal prognosis, with a high rate of cervical lymph node metastasis and distant metastasis. Surgery with postoperative chemoradiation therapy is the main treatment for hypopharyngeal cancer. Treatment choices should be made according to TNM stage and overall health conditions in order to achieve ideal oncologic and functional results.