Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, 70456, Taiwan.
Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Ann Surg Oncol. 2023 Feb;30(2):1169-1181. doi: 10.1245/s10434-022-12744-1. Epub 2022 Nov 6.
To cure advanced hypopharyngeal squamous cell carcinoma (HPSCC), primary operation followed by adjuvant (chemo-)radiotherapy (OP-CRT) or definitive chemoradiation (CCRT) are the two primary options. This study aimed to compare the failure patterns and long-term survival outcomes of HPSCC patients treated with these two strategies. PATIENTS AND METHODS: From 2007 to 2015, 198 pathologically confirmed HPSCC patients receiving either OP-CRT or CCRT were retrospectively reviewed. Failure patterns and survival outcomes stratified by the 7th American Joint Committee on Cancer staging system and treatment modalities were compared.
One hundred and eighty-nine patients (95.4%) were stage III/IV and 62 patients (31.3%) received OP-CRT. Median follow-up duration was 4.9 years. Compared with CCRT, OP-CRT provided better 3-year local relapse-free survival for T3 (93 vs 48%, p < 0.0001), T4a (88 vs 37%, p = 0.0005) and better 3-year regional relapse-free survival for N2b+2c (93 vs 60%, p < 0.0001). Of note, for stage IVA subjects, OP-CRT provided better 3-year loco-regional relapse-free survival (85 vs 37%, p < 0.0001), marginal poor 3-year distant metastasis-free survival (62 vs 79%, p = 0.06), but comparable 3-year OS (52 vs 44%, p = 0.37) and 5-year OS (44 vs 31%, p = 0.15) compared with CCRT.
For patients with advanced HPSCC, although OP-CRT and CCRT provided similar overall survival, failure patterns were distinct. OP-CRT provided better loco-regional control but was more likely to encounter distant metastases than CCRT. The detailed analysis of failure patterns will pave the way to improve this devastating disease.
为了治愈晚期下咽鳞状细胞癌（HPSCC），主要治疗方案包括原发手术联合辅助（放）化疗（OP-CRT）或根治性放化疗（CCRT）。本研究旨在比较两种治疗方案治疗 HPSCC 患者的失败模式和长期生存结果。
回顾性分析 2007 年至 2015 年间 198 例经病理证实的 HPSCC 患者，这些患者分别接受了 OP-CRT 或 CCRT。比较了按照第 7 版美国癌症联合委员会（AJCC）分期系统和治疗方式分层的失败模式和生存结果。
189 例（95.4%）患者为 III/IV 期，62 例（31.3%）患者接受了 OP-CRT。中位随访时间为 4.9 年。与 CCRT 相比，OP-CRT 为 T3（93% vs. 48%，p<0.0001）和 T4a（88% vs. 37%，p=0.0005）患者提供了更好的 3 年局部无复发生存率，为 N2b+2c 患者提供了更好的 3 年区域无复发生存率（93% vs. 60%，p<0.0001）。值得注意的是，对于 IVA 期患者，OP-CRT 为患者提供了更好的 3 年局部区域无复发生存率（85% vs. 37%，p<0.0001），但远处无转移生存率略差（62% vs. 79%，p=0.06），3 年总生存率（52% vs. 44%，p=0.37）和 5 年总生存率（44% vs. 31%，p=0.15）与 CCRT 相似。
对于晚期 HPSCC 患者，虽然 OP-CRT 和 CCRT 的总生存率相似，但失败模式不同。OP-CRT 提供了更好的局部区域控制，但比 CCRT 更有可能发生远处转移。对失败模式的详细分析将为改善这种毁灭性疾病铺平道路。
