Short- and long-term outcomes of endoscopic submucosal dissection for superficial pharyngeal squamous cell carcinoma in older adult patients.

BACKGROUND

Superficial pharyngeal squamous cell carcinoma (PSCC) is increasingly detected owing to advancements in image-enhanced endoscopy, with endoscopic submucosal dissection (ESD) emerging as a minimally invasive treatment option. Nutritional status, including indices such as body mass index (BMI), prognostic nutritional index, and geriatric nutritional risk index (GNRI), influences outcomes in head and neck cancer. However, prognostic factors specific to older adults with superficial PSCC remain unclear.

METHODS

This study included 98 patients aged ≥ 75 years who underwent ESD for superficial PSCC. Clinicopathological data, nutritional status, comorbidities, and American Society of Anesthesiologists physical status (ASA-PS) were assessed. Multivariable Cox proportional hazards regression analysis was performed to identify independent prognostic factors for overall survival (OS).

RESULTS

Of the participants, 37 (37.8%) were aged ≥ 80 years. Eighteen (18.4%) and 17 (17.3%) patients had an ASA-PS ≥ 3 and GNRI < 92, respectively. Lymph node metastasis was observed in two patients. No patient experienced disease-specific mortality. The median OS was 109 months, with a 5-year OS rate of 78.1%. Age (p = 0.032), BMI (p = 0.024), ASA-PS (p < 0.01), and GNRI (p = 0.029) were identified as independent prognostic factors for OS. Patients aged ≥ 80 years with ASA-PS < 3 or GNRI ≥ 92 had a median OS of 95.0 months, whereas those aged < 80 years with ASA-PS ≥ 3 and GNRI < 92 had a median OS of 66.0 and 69.0 months, respectively.

CONCLUSIONS

Age, BMI, ASA-PS, and GNRI were significant prognostic factors for OS in older adults undergoing ESD for superficial PSCC. These findings may inform tailored treatment strategies to improve outcomes in this population.