Clinical manifestations of hypopharynx squamous cell carcinoma and treatment outcomes according to age at diagnosis

Old age decreases the risk of lymph node metastasis in T1-2 hypopharynx squamous cell carcinoma patients

Cervical lymph node metastasis (LNM) is an important prognostic factor for hypopharynx squamous cell carcinoma (SCC) patients, which can be detected in a large fraction of clinically diagnosed early hypopharynx SCC patients; however, the importance of knowing the risk of LNM in the younger/older patients has not been well defined. The objective of this study is to assess the effect of age and LNM in T1-2 hypopharynx SCC patients. Patients with T1-2 hypopharynx SCC were extracted from the Surveillance, Epidemiology and End Results database between 2005 and 2014. Univariate and multivariate logistic regression models were produced to recognize the association between age and risk factors of LNM. A total of 1018 patients were analyzed. Older patients have a lower risk of LNM compared with their younger peers (P < 0.01). In multivariate analyses, older age was associated with a significantly lower risk of LNM. Compared with patients aged 80-93 years old, the hazard ratios for patients aged 31-49, 50-59, 60-69, and 70-79 years old were 2.464 [95% confidence interval (CI): 1.338-4.537], 2.668 (95% CI: 1.638-4.346), 3.192 (95% CI: 1.957-5.205), and 1.564 (95% CI: 0.945-2.588), respectively. Subgroup analysis shows that the effect of older age was significantly associated with a higher risk of LNM in Caucasian male who harbored moderately/poorly differentiated tumors. Our study demonstrates that older patients with T1-2 hypopharynx SCC had a lower risk of LNM than their younger peers, especially males with moderately/poorly differentiated tumors. More accurate assessments of LNM and prophylactic neck dissection or prophylactic adjuvant radiation therapy to the neck will be imperative for reducing recurrence in younger T1-2 hypopharynx SCC.

[Surgical Treatment of Hypopharyngeal Carcinoma, Neck Dissection and Adjuvant Postoperative Therapy of Oropharyngeal and Hypopharyngeal Cancer: Recommendations of the current S3 Guideline - Part II]

Part II of the S3 guideline report deals with the surgical treatment of hypopharyngeal carcinoma, neck dissection for oropharyngeal and hypopharyngeal carcinomas and adjuvant therapy options. Primary surgical therapy ± adjuvant radio- or radiochemotherapy and primary radio- or radiochemotherapy are established as primary therapies for local-regional hypopharyngeal carcinomas. Direct randomized comparisons of both basic therapeutic procedures were never conducted. Available registry data show a worse prognosis of hypopharyngeal carcinoma compared to oropharyngeal carcinomas in all locoregional tumor stages, regardless of the treatment method. For T1N0-T2N0 squamous cell carcinoma of the hypopharynx, there are no relevant differences in overall survival and locoregional relapse rate between primary surgical and primary non-surgical treatment. Primary surgical therapy ± adjuvant radiotherapy or radiochemotherapy and primary radiotherapy or radiochemotherapy are established as primary therapies for advanced but locoregionally limited hypopharyngeal carcinomas. Neck dissection is an integral part of the primary surgical treatment of oropharyngeal and hypopharyngeal cancer. There are only a few randomized studies on non-surgical organ preservation for advanced hypopharyngeal cancer as an alternative to pharyngolaryngectomy, but these have led to the recommendation of alternative concepts in the new guideline. The indication and implementation of postoperative adjuvant radiotherapy and radiochemotherapy for hypopharyngeal carcinoma do not differ from those for HPV/p16-negative and -positive oropharyngeal carcinoma.

Risk Factors for Synchronous Lung Metastasis in Squamous Cell Carcinoma of Hypopharynx

Background: The objective of this study is to assess the risk factors for synchronous lung metastases (LM) in patients with hypopharynx squamous cell carcinomas (HPSCC). Methods: HPSCC patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2013. We examined the association between risk factors and synchronous LM using chi-squared tests. Predictors of survival rates were assessed using univariate and multivariate analyses. Results: A total of 1683 patients were analyzed, including 70 patients (4.2%) with synchronous LM, and 1613 patients without synchronous LM (95.8%). Multivariate logistic regression analysis showed that Caucasian (P = .038), lower T (P = .026) or N classification (P = .000), and highly differentiated disease (P = .002) were associated with a significantly lower risk of LM. Elderly not married patients with higher T or N classification, multiple sites of metastases, and no surgical therapy to the primary tumors were more likely to reduce life expectancy. Conclusion: By analyzing data from a large cohort, Caucasian, lower T or N classification, and highly differentiated disease were associated with a significantly lower risk of LM. Elderly not married patients with advanced T or N classification, no surgical therapy to the primary tumors, and multiple sites of metastases were more likely to reduce life expectancy. More accurate assessments of LM will be imperative for early diagnosis and treatment in non-Caucasian patients who harbored higher T or N classification and poorly differentiated disease.

Development and validation of a nomogram to predict cancer-specific survival in patients with hypopharyngeal squamous cell carcinoma treated with primary surgery

OBJECTIVE

We aimed to develop a nomogram to predict cancer-specific survival (CSS) in patients with hypopharyngeal squamous cell carcinoma (HSCC) treated with primary surgery to provide more accurate risk stratification for patients.

METHODS

We retrospectively collected data of 1144 eligible patients with HSCC from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. Patients were randomly divided into training and validation groups (ratio 6:4) and we used univariate and multivariate Cox analysis. We developed and validated a nomogram using calibration plots and time-dependent receiver operating characteristic, Kaplan-Meier, and decision curves.

RESULTS

Age; marital status; T, N, and M stage; and postoperative adjuvant therapy were independent factors associated with CSS, which were included in the nomogram. The nomogram's C-index was 0.705 to 0.723 in the training group and 0.681 to 0.736 in the validation group, which were significantly higher than conventional American Joint Committee on Cancer (AJCC) staging. Calibration curves showed good agreement between prediction and observation in both groups. Kaplan-Meier and decision curves suggested the nomogram had better risk stratification and net benefit than conventional AJCC staging.

CONCLUSIONS

We established a nomogram that was superior to conventional AJCC staging in predicting CSS for HSCC.