| Part I Efficacy of endoscopic submucosal dissection for superfici al hypopharyngeal carcinomaObjective: To analyze the therapeutic effect of endoscopic submucosal dissection(ESD)in 66 patients with early hypopharyngeal carcinoma and precancerous lesions.Methods: Clinical data of 66 cases of early hypopharyngeal cancer and precancerous lesions diagnosed by endoscopy and pathology from December2015 to September 2022 were analyzed retrospectively.The en bloc resection rate,complete resection rate,curative resection rate,lesion size,operation time,postoperative complications and follow-up were evaluated.Results: 66 cases with 76 lesions received ESD,with the en bloc resection rate of 100%(76/76)and the complete resection rate of 90.8%(69/76).The median length of lesions was 22 mm(10-50mm),and the median operation time was 60 minutes(15-218 minutes).The incidence of laryngeal edema after ESD was 21.2%(14/66),and no temporary tracheotomy was performed.The incidence of aspiration pneumonia was 9.1%(6/66),and that of pharyngeal stenosis rate was 3.0%(2/66).When the length of hypopharyngeal lesions was greater than 30 mm,the incidence of postoperative complications of ESD was33.3%(5/15),and it was quite likely to be multiple complications.Pathological results revealed that 1 low-grade intraepithelial neoplasia,36 high-grade intraepithelial neoplasia,30 intraepithelial carcinomas,and 9 subepithelial carcinomas;4 lesions had positive vertical margin,including 1 lesion with vascular invasion;2 lesions had positive horizontal margin,1 lesion had vascular invasion,with positive vertical margin and positive horizontal margin;1 lesion had vascular invasion,with the curative excision rate was 89.5%(68/76).The median follow-up period was 25.5 months(1-77 months).1 patient developed cervical lymph node metastasis,which disappeared after additional chemoradiotherapy.The 5-year overall survival rate was 72.0%,and the recurrence-free survival rate was 97.1%.Conclusion: ESD is safe,effective and minimally invasive for early hypopharyngeal carcinoma and precancerous lesions,which has a broad application prospect.Part II Influencing factors of hypopharyngeal cancer complicate d by esophageal cancer and their prediction modelObjective: Through the retrospective study of hypopharyngeal cancer and esophageal cancer cases,the risk factors of hypopharyngeal cancer complicated with esophageal cancer were analyzed,and the prediction model was constructed for clinical screening of high-risk patients,providing theoretical support for clinical diagnosis and treatment.Methods: Clinical data of 446 patients diagnosed with hypopharyngeal cancer in the Endoscopy Department of Sichuan Cancer Hospital from December 2013 to November 2022 were collected to analyze the correlation between hypopharyngeal cancer complicated with esophageal cancer and other indicators,such as age,gender,nationality,smoking history,drinking history,tumor involvement site and TNM stage,et al.In univariate analysis,t test was used for measurement data and χ2 test was used for statistical analysis for counting data.Binary Logistic multivariate regression analysis was performed for P<0.05 indicators to screen the risk factors of hypopharyngeal cancer complicated with esophageal cancer,and a prediction model was established.Hosmer-lemeshowχ2 test was used to test the goodness-of-fit of the model,and the predictive value of risk indexes in hypopharyngeal cancer complicated with esophageal cancer was evaluated by drawing receiver-operating characteristic curve and calculating the area under the receiver-operating characteristic curve.Results: A total of 446 patients were included in this study.Uni-variate analysis showed that:Age(<55 years old)(P=0.041),alcohol consumption(P=0.011),tumor site(P=0.007),tumor invasion site ≥3 anatomical regions(P=0.011),hypopharyngeal cancer TNM stage(P<0.001)and cervical lymph node metastasis(P<0.001)were statistically significant.Binary Logistic multivariate regression analysis showed that age(<55 years old)(P=0.045,OR=1.575,95%CI=1.010-2.455),alcohol consumption(P=0.016,OR=1.900,95%CI=1.130-3.196),The tumor invaded more than 3 anatomical regions(P=0.001,OR=2.061,95%CI=1.370-3.099),and the TNM stage Ⅲof hypophary-ngeal cancer(P=0.014,OR=3.412,95%CI=1.284-9.066)was an independent risk factor for hypopharyngeal cancer complicated with esophageal cancer.The prediction model(Logit model)was established according to the above influencing factors: Logit P=0.454×age(<55 years old)+0.642×alcoholconsumption+0.723×tumor invasion sites≥3+1.227×StageⅢ:Prob-ability model for predicting concurrent esophageal cancer:P=1/{1+Exp(-0.454×age(<55 years old)-0.642×alcohol consumption-0.723×tumor invasion site ≥3-1.227×Stage Ⅲ)}.Hosmer-lemeshow χ2 test was used to test the fitting degree of the prediction model,and the P=0.610>0.05,which was not statistically significant,indicating that the prediction model had a good fitting degree.ROC curve analysis results suggested that AUC was 0.675(95%CI=0.626-0.724)and Youden index was 0.268.The sensitivity was 75.1% and the specificity was 51.6%,which could be used to predictthe risk of the disease.Conclusion: The results of this study show that the age of patients(<55years old),alcohol consumption,the number of tumor invasion sites≥3anatomical regions,and the TNM stage Ⅲ of hypopharyngeal cancer is closely related to hypopharyngeal cancer complicated with esophageal cancer.The prediction model established by this method has a good fit,which can provide some guidance for clinical diagnosis and treatment.The incidence of hypopharyngeal carcinoma with esophageal carcinoma is relatively high.Fine gastroscopy should be performed for hypopharyngeal cancer patients with the above risk factors. |
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