Chen Chun, Hang Lei, Liu Yupeng, Xie Jin, Yang Jun
Department of Otorhinolaryngology-Head & Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
Ear Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
Cancers (Basel). 2022 Jun 27;14(13):3146. doi: 10.3390/cancers14133146.
Background: Postcricoid carcinoma is a rare but aggressive type of hypopharyngeal carcinoma with poor prognosis and high mortality; thus, it is indispensable to investigate the surgical efficacy and multimodal strategies. Methods: This retrospective study included postcricoid carcinoma patients undergoing surgical resection from 2008 to 2022. Treatment methods and clinical characteristics were analyzed to evaluate prognostic factors for oncological outcomes. Results: Of 72 patients, 13 cases were in the I−II stage and 59 in the III−IV stage. The overall survival (OS) was 50.0%; the laryngeal function preservation rate was 69.4%. Univariate analysis found that high mortality was associated with low tumor differentiation, lymph node metastasis, neck recurrence, and smoke history via log-rank test (p < 0.05); postoperative radiotherapy (RT) remained positive in OS (p = 0.04). The multivariable model further revealed that lymph node metastasis was a dominant determinant after accounting for covariates (HR 1.75; 95% CI 0.85−3.59). The data also indicated that neoadjuvant chemotherapy (NAC) and tumor diameter ≤ 2 cm were causing lower rates of pharyngeal fistula and locoregional relapse. Conclusions: Surgeons should emphasize high-risk features and optimize individualized surgical procedures for postcricoid carcinoma patients. Combined with multimodal treatments, it is feasible to reconstruct laryngeal function and lessen postoperative morbidities in advanced patients.
环状软骨后癌是一种罕见但侵袭性强的下咽癌，预后差、死亡率高；因此，研究其手术疗效和多模式治疗策略至关重要。方法：这项回顾性研究纳入了2008年至2022年接受手术切除的环状软骨后癌患者。分析治疗方法和临床特征以评估肿瘤学结局的预后因素。结果：72例患者中，13例处于I-II期，59例处于III-IV期。总生存率（OS）为50.0%；喉功能保留率为69.4%。单因素分析发现，通过对数秩检验，高死亡率与低肿瘤分化、淋巴结转移、颈部复发和吸烟史相关（p<0.05）；术后放疗（RT）在总生存率方面仍呈阳性（p = 0.04）。多变量模型进一步显示，在考虑协变量后，淋巴结转移是主要决定因素（HR 1.75；95%CI 0.85-3.59）。数据还表明，新辅助化疗（NAC）和肿瘤直径≤2 cm导致咽瘘和局部区域复发的发生率较低。结论：外科医生应重视环状软骨后癌患者的高危特征，优化个体化手术方案。结合多模式治疗，重建晚期患者的喉功能并降低术后发病率是可行的。
