Clinical Diagnosis And Treatment Of Synchronous Primary Cancers Of Hypopharyngeal And Esophageal

PurposeReview the clinical data of patients with hypopharyngeal-esophageal dual primary cancer admitted to Qilu Hospital of Shandong University,compare the survival analysis of different treatment methods,and analyze the characteristics of pathogenic factors,pathological characteristics,treatment methods and prognosis of hypopharyngeal-esophageal dual primary cancer.The purpose is to provide a reference for the prevention,early diagnosis and treatment of dual primary hypopharyngeal-esophageal cancer.MethodsCollected clinical data of patients with dual primary pharyngeal-esophageal cancer who were treated in Qilu Hospital of Shandong University from February 2003 to September 2019 According to the multiple primary cancer diagnostic criteria proposed by Warren,eligible patients with dual primary pharyngeal-esophageal cancer were included.The Kaplan-Meier method was used to calculate the survival rate of patients;the Log-Rank test was used to compare whether the survival rates were different between groups;the COX risk proportional regression model was used to explore the prognostic impact on the overall survival rate.The test level is a=0.05.When P<0.05,the difference is considered statistically significant.After excluding missing patients from the study,the complete follow-up data of 84 patients were finally obtained,including 62 patients with simultaneous dual primary cancer and 22 patients with heterochronous dual primary cancer,with an overall follow-up rate of 93%.Result1.This study included a total of 90 patients with hypopharyngeal-esophageal dual primary cancer.To determine whether the interval between diagnoses exceeds 6 months,define simultaneous dual primary cancer and heterochronous dual primary cancer.There were 67 patients with simultaneous dual primary cancer and 23 patients with metachronous dual primary cancer.Both the clinical and pathological staging criteria for hypopharyngeal and esophageal cancer adopt the latest revised American Cancer Society(AJCC)eighth edition staging.2.The 84 patients with hypopharyngeal-esophageal dual primary cancer were all men,with a median age of 54 years.Of the 84 patients,80 patients were diagnosed with second primary cancer within 60 months,accounting for 95.55%.A total of 62 patients with concurrent primary hypopharyngeal-esophageal cancer had a median survival time of 23 months.The 1-year survival rate was 75.5%,the 2-year survival rate was 64.0%,and the 3-year survival rate was 34.4%.A total of 22 patients with metachronous hypopharyngeal-esophageal dual primary cancer had a median survival time of 79 months,a 3-year survival rate of 85.9%,and a 5-year survival rate of only 57.3%.The Log-Rank method was used to test the survival difference between the two groups of simultaneous and metachronous dual primary cancer.The results showed that the overall survival time of patients in the metachronic group was longer than that of the simultaneous group,and the difference in survival time was statistically significant(P<0.01)3.Of the 62 patients with concurrent hypopharyngeal-esophageal dual primary cancer,the median survival time of 28 patients treated with surgery was 34 months,with a 1-year survival rate of 96.3%,2-year survival rate of 65.9%,and 3-year survival rate.The survival rate was 49.4%.The median survival time of 24 patients treated with radiochemotherapy alone was 19 months.The 1-year survival rate was 70.8%,the 2-year survival rate was 36.7%,and the 3-year survival rate was 22.9%.The median survival time of 10 patients who received supportive treatment was 23 months.The 1-year survival rate was 40.0%,the 2-year survival rate was 20.0%,and the 3-year survival rate was 10.0%.The difference in survival time between the three treatment groups was statistically significant(P<0.001).For the indicators with statistical differences in single factor analysis,multi-factor analysis is conducted through the COX proportional regression model.The results showed that drinking index>10000 was an independent risk factor affecting prognosis(HR=2.793,95%CI 1.264-4.517,P=0.024).The prognosis of surgical treatment is better than that of radiotherapy and chemotherapy alone(P?0.047),and the prognosis of radiotherapy and chemotherapy alone is better than supportive therapy(P=0.021)4.For 22 patients with heteropharyngeal-esophageal metachronous dual primary cancer,according to whether the first primary cancer and the second primary cancer were radically treated,Log-Rank test was used to perform univariate analysis to compare their survival differences.The results show that whether radical surgery is performed is a risk factor that affects the patient's overall survival time.Conclusions1.The prognosis of hypopharyngeal-esophageal dual primary cancer is poor,and the prognosis is worse.The drinking index and whether to perform radical surgery are independent factors affecting the prognosis of patients with hypopharyngeal-esophageal dual primary cancer.2.In the clinical diagnosis and treatment of hypopharyngeal cancer,attention should be paid to the possibility of esophageal cancer.Preoperative routine gastroscopy can improve the detection rate of the disease.3.Actively adopting personalized comprehensive treatment with surgery-based radiotherapy and chemotherapy as a supplement has better clinical efficacy.4.1-5 years after the diagnosis of the first primary cancer is the peak period for the diagnosis of the second primary cancer.During this period,attention should be paid to patient review and follow-up.