Xiao Qihui, Dong Pin, Chen Xinwei, Ying Xingjiang, Liu Yuyin, Chen Lixiao, Ding Jian
Department of Otorhinolaryngology & Head and Neck Surgery，Shanghai General Hospital，Shanghai Jiao Tong University School of Medicine，Shanghai，200080，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Sep;37(9):700-707. doi: 10.13201/j.issn.2096-7993.2023.09.004.
To analyze the risk factors that affect the prognosis of patients with hypopharyngeal squamous cell carcinoma（HPSCC） and to compare the efficacy of surgical resection followed by adjuvant radiotherapy（SR） with that of neoadjuvant therapy consisting of platinum-based chemotherapy and fluorouracil combined with either cetuximab or nimotuzumab, followed by SR. The study also aimed to evaluate the overall survival（OS） of patients, their postoperative eating function, tracheostomy decannulation rate, and tumor response to the two neoadjuvant chemotherapies. A retrospective analysis was performed on the medical records of HPSCC patients who received SR or neoadjuvant therapy followed by SR treatment at the Shanghai General Hospital from 2012 to 2019 and had not undergone any prior treatment. The prognostic factors were analyzed, and the survival analysis of patients who underwent SR treatment with two neoadjuvant chemotherapy regimens was performed. A total of 108 patients were included in the study. The results of the univariate analysis showed that gender（=0.850） had no significant correlation with the survival rate of HPSCC patients who underwent SR. However, age, smoking history, alcohol consumption history, platelet-to-lymphocyte ratio（PLR）, neutrophil-to-lymphocyte ratio（NLR）, T stage, N stage, neoadjuvant therapy with either cetuximab or nimotuzumab combined with platinum-based chemotherapy and fluorouracil, and histological grade were significantly associated with prognosis（<0.05）. The multivariate analysis revealed that smoking history, histological grade, and neoadjuvant therapy with either cetuximab or nimotuzumab combined with platinum-based chemotherapy and fluorouracil were independent risk factors affecting the prognosis of HPSCC（<0.05）. Patients who received neoadjuvant therapy had longer OS than those who underwent SR only（<0.001）. There was no significant difference in tumor response to the two neoadjuvant therapies and in OS（>0.05）, and there was no significant difference in the rate of oral feeding and tracheostomy decannulation among the three treatment groups（>0.05）. Univariate analysis showed that age at tumor onset, smoking history, alcohol consumption history, NLR, PLR, T stage, N stage, whether receiving neoadjuvant chemotherapy, and pathological grade were associated with the prognosis of HPSCC patients receiving SR treatment. Multivariate analysis showed that smoking history, pathological grade, and neoadjuvant chemotherapy were independent risk factors affecting the prognosis. Neoadjuvant chemotherapy with cetuximab or nimotuzumab can prolong the OS of patients, providing a certain basis and reference for the treatment of HPSCC.
分析影响下咽鳞状细胞癌（HPSCC）患者预后的危险因素，并比较手术切除后辅助放疗（SR）与新辅助治疗（由铂类化疗和氟尿嘧啶联合西妥昔单抗或尼妥珠单抗组成，随后进行SR）的疗效。该研究还旨在评估患者的总生存期（OS）、术后进食功能、气管造口脱管率以及肿瘤对两种新辅助化疗的反应。对2012年至2019年在上海交通大学医学院附属瑞金医院接受SR或新辅助治疗后再行SR治疗且未接受过任何先前治疗的HPSCC患者的病历进行回顾性分析。分析预后因素，并对接受两种新辅助化疗方案的SR治疗患者进行生存分析。共纳入108例患者。单因素分析结果显示，性别（=0.850）与接受SR治疗的HPSCC患者生存率无显著相关性。然而，年龄、吸烟史、饮酒史、血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR）、T分期、N分期、西妥昔单抗或尼妥珠单抗联合铂类化疗和氟尿嘧啶的新辅助治疗以及组织学分级与预后显著相关（<0.05）。多因素分析显示，吸烟史、组织学分级以及西妥昔单抗或尼妥珠单抗联合铂类化疗和氟尿嘧啶的新辅助治疗是影响HPSCC预后的独立危险因素（<0.05）。接受新辅助治疗的患者OS长于仅接受SR治疗的患者（<0.001）。两种新辅助治疗的肿瘤反应和OS无显著差异（>0.05），三个治疗组的经口进食率和气管造口脱管率也无显著差异（>0.05）。单因素分析显示，肿瘤发病年龄、吸烟史、饮酒史、NLR、PLR、T分期、N分期、是否接受新辅助化疗以及病理分级与接受SR治疗的HPSCC患者预后相关。多因素分析显示，吸烟史、病理分级和新辅助化疗是影响预后的独立危险因素。西妥昔单抗或尼妥珠单抗新辅助化疗可延长患者OS，为HPSCC治疗提供一定依据和参考。
