Hypopharyngeal Squamous Cell Carcinoma in Elderly Patients Aged ≥70 Years: Surgery and Postoperative Radiotherapy Improves Outcomes in Selected Patients.

OBJECTIVE

To summarize the efficacy of surgery plus postoperative radiotherapy as initial treatment in elderly patients aged ≥70 years with advanced hypopharyngeal cancer and to analyze prognostic factors.

METHODS

Retrospective analysis of 77 elderly patients aged ≥70 years with stage III-IV hypopharyngeal squamous cell carcinoma who underwent surgery as initial treatment at Shandong Provincial ENT Hospital between 2006-2020. Treatment completion rate and prognostic factors were summarized and analyzed, with comparisons made to non-surgical treatments in published literature. SPSS 26.0 was used for analysis. Univariate Cox regression analysis was applied to identify potential predictors of overall survival (OS) and disease-free survival (DFS). Kaplan-Meier method with Log rank test was used to calculate and compare survival rates. Multivariate analysis employed the Cox proportional hazards regression model, with  < 0.05 considered statistically significant.

RESULTS

The study achieved 100% follow-up with a median duration of 62 months. Among the cohort, 26 patients received surgery only whilst 51 received surgery plus radiotherapy, seven patients failed to complete radiotherapy resulting in a completion rate of 86.27%. Survival analysis revealed significant intergroup differences: at 1 year, OS/DFS rates were 76.9%/73.1% in Group A versus 93.2%/81.8% in Group B (both  < 0.05). By 3 years, OS/DFS rates were 61.5%/57.7% in Group A versus 77.3%/70.5% in Group B. The overall 3-year and 5-year OS rates for the cohort were 68.8% and 52.3%, respectively. Univariate analysis showed no significant differences in gender, age, T/N staging, comorbidities, or second primary malignancies (all ** > 0.05), but treatment modality was a significant predictor of both OS ( = 0.002) and DFS ( = 0.001). Multivariate COX regression analysis confirmed N staging and treatment modality as independent prognostic factors for OS ( = 0.007 and 0.002, respectively) and DFS (P = 0.009 and 0.002, respectively).

CONCLUSION

Elderly hypopharyngeal cancer patients tolerated surgery and postoperative radiotherapy well. Active pursuit of comprehensive treatment is recommended for fit stage III-IV patients aged ≥70 years to improve outcomes.