Petersen Japke F, Timmermans Adriana J, van Dijk Boukje A C, Overbeek Lucy I H, Smit Laura A, Hilgers Frans J M, Stuiver Martijn M, van den Brekel Michiel W M
Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Department of Research, Comprehensive Cancer Organization The Netherlands (IKNL), Utrecht, The Netherlands.
Eur Arch Otorhinolaryngol. 2018 Jan;275(1):181-189. doi: 10.1007/s00405-017-4766-6. Epub 2017 Oct 28.
Hypopharynx cancer has the worst prognosis of all head and neck squamous cell cancers. Since the 1990s, a treatment shift has appeared from a total laryngectomy towards organ preservation therapies. Large randomized trials evaluating treatment strategies for hypopharynx cancer, however, remain scarce, and frequently this malignancy is evaluated together with larynx cancer. Therefore, our aim was to determine trends in incidence, treatment and survival of hypopharynx cancer. We performed a population-based cohort study including all patients diagnosed with T1-T4 hypopharynx cancer between 1991 and 2010 in the Netherlands. Patients were recorded by the national cancer registry database and verified by a national pathology database. 2999 patients were identified. The incidence increased significantly with 4.1% per year until 1997 and decreased non-significantly afterwards. For women, the incidence increased with 1.7% per year during the entire study period. Total laryngectomy as primary treatment significantly decreased, whereas radiotherapy and chemoradiation increased. The 5-year overall survival significantly increased from 28% in 1991-2000 to 34% in 2001-2010. Overall survival for T3 was equal for total laryngectomy and (chemo)radiotherapy, but for T4-patients the survival was significantly better after primary total laryngectomy (± adjuvant radiotherapy). This large population-based study demonstrates a shift in treatment preference towards organ preservation therapies. The 5-year overall survival increased significantly in the second decade. The assumed equivalence of organ preservation and laryngectomy may require reconsideration for T4 disease.
下咽癌在所有头颈部鳞状细胞癌中预后最差。自20世纪90年代以来，治疗方式已从全喉切除术转向器官保留疗法。然而，评估下咽癌治疗策略的大型随机试验仍然很少，而且这种恶性肿瘤经常与喉癌一起评估。因此，我们的目的是确定下咽癌的发病率、治疗和生存趋势。我们进行了一项基于人群的队列研究，纳入了1991年至2010年期间在荷兰被诊断为T1 - T4期下咽癌的所有患者。患者由国家癌症登记数据库记录，并经国家病理数据库核实。共确定了2999名患者。直到1997年发病率每年显著上升4.1%，之后非显著下降。对于女性，在整个研究期间发病率每年上升1.7%。作为主要治疗方式的全喉切除术显著减少，而放疗和放化疗增加。5年总生存率从1991 - 2000年的28%显著提高到2001 - 2010年的34%。T3期患者全喉切除术和（放）化疗的总生存率相当，但对于T4期患者，初次全喉切除术（±辅助放疗）后的生存率显著更高。这项基于大量人群的研究表明治疗偏好已转向器官保留疗法。在第二个十年中5年总生存率显著提高。对于T4期疾病，器官保留和喉切除术等效的假设可能需要重新考虑。
