Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan.
Oral Oncol. 2022 Feb;125:105683. doi: 10.1016/j.oraloncology.2021.105683. Epub 2021 Dec 29.
The invasion into cervical esophagus (ICE) sometimes could be encountered in patients with hypopharyngeal squamous cell carcinoma (HypoSCC). However, the incidence, predictive factors, and prognostic impact of ICE on the patients with HypoSCC remain unclear.
Patient diagnosis with HypoSCC at the National Taiwan University Hospital between January 2007 and December 2018 were reviewed. All patients were classified into two groups: with and without ICE. The curative treatment included upfront laryngectomy or pharyngo-laryngo-esophagectomy (PLE) with adjuvant chemoradiation, or definite organ-sparing chemoradiation.
We analyzed 527 HypoSCC patients, 71 (13.47%) with and 456 (86.53%) without ICE. ICE presented more frequently in females (odds ratio (OR) = 3.01, p = 0.03) and posterior pharyngeal wall (OR = 2.34, p = 0.04). The 5-year disease-free survival of patients with and without ICE were 21.7% and 54.1%, respectively (p < 0.0001) and the 5-year overall survival were 13.1% and 53.8%, respectively (p < 0.0001). Among patients with ICE, the disease-free and overall survival of patients with upfront PLE were worse than the patients without upfront PLE (p = 0.21 and p = 0.27, respectively). After multivariant cox analysis, ICE was an independent risk factor for disease-free survival (p < 0.001) and overall survival (p < 0.001).
ICE was occasionally present (13.47%) in HypoSCC patients. Unfortunately, the presence of ICE had a significant impact on disease-free and overall survival. For the HypoSCC patients with ICE, organ-sparing chemoradiation should be considered first as upfront PLE had no additional benefit.
颈段食管侵犯（ICE）在咽鳞癌（HypoSCC）患者中偶有发生。然而，HypoSCC 患者中 ICE 的发生率、预测因素和对预后的影响尚不清楚。
回顾性分析 2007 年 1 月至 2018 年 12 月期间在台湾大学医院诊断为 HypoSCC 的患者。所有患者分为两组：有 ICE 组和无 ICE 组。治疗方式包括初始喉切除术或咽-喉-食管切除术（PLE）联合辅助放化疗，或明确的器官保留放化疗。
共分析了 527 例 HypoSCC 患者，其中 71 例（13.47%）有 ICE，456 例（86.53%）无 ICE。女性（优势比（OR）=3.01，p=0.03）和后咽壁（OR=2.34，p=0.04）更易发生 ICE。有 ICE 组和无 ICE 组患者的 5 年无病生存率分别为 21.7%和 54.1%（p<0.0001），5 年总生存率分别为 13.1%和 53.8%（p<0.0001）。在有 ICE 的患者中，初始 PLE 治疗的患者与未行初始 PLE 治疗的患者相比，无病生存率（p=0.21）和总生存率（p=0.27）更差。多变量 Cox 分析后，ICE 是无病生存率（p<0.001）和总生存率（p<0.001）的独立危险因素。
ICE 在 HypoSCC 患者中偶尔发生（13.47%）。不幸的是，ICE 的存在对无病生存率和总生存率有显著影响。对于有 ICE 的 HypoSCC 患者，应首先考虑器官保留放化疗，因为初始 PLE 并不能带来额外的获益。
