Treatment sequence and survival in locoregionally advanced hypopharyngeal cancer: A surveillance, epidemiology, and end results–based study

Abstract

Objectives/Hypothesis: The objective of this study was to examine the association between modality of primary treatment and survival among patients with locoregionally advanced hypopharyngeal cancer. Study Design: Retrospective cohort. Methods: There were 2,328 adult patients diagnosed with stage III or IV, M0, hypopharyngeal squamous cell carcinoma identified within the Surveillance, Epidemiology and End Results (SEER) registry (years 2004-2015). Patients who received primary chemoradiation (CRT) were compared to those who received surgery with either adjuvant radiation therapy (S + RT), or surgery with adjuvant CRT (S + CRT). The latter primary surgery group (S + Adj) was also analyzed collectively. Overall survival (OS) and disease-specific survival (DSS) were assessed using Kaplan-Meier analyses and Cox regression models using a propensity score to adjust for factors associated with treatment allocation. Results: Median survival was 20 months (interquartile range [IQR] = 10-45) with CRT and 25 months

Development and Validation of a Prognostic Nomogram for Hypopharyngeal Carcinoma

“…Our SEER data showed that in America, radiotherapy alone is the most common treatment modality for HSCC (80.8%), followed by surgery plus radiotherapy (14.1%). Consistent with previous studies ( 6 – 8 ), this study showed that local treatment patterns were independent prognostic factors for survival ( Table 2 and Figure 2K ). A population‐based cohort study that involved 6647 HSCC patients showed that the best 5-year OS rate (48.5%) was achieved with a combination of surgery and radiation therapy.…”

“…Heng Y et al recently developed a prognostic nomogram for Chinese patients with HSCC after tumor resection, which served as a stratification indication for postoperative adjuvant treatment (13). However, the optimal initial treatment modality for locally advanced HSCC has not been fully defined and was identified as an important prognostic factor (6)(7)(8). Thus, in this SEER-based study, we analyzed the effect of local treatment (surgery and/or radiotherapy) and chemotherapy on OS.…”

“…Previous SEER-based studies have analyzed the tumor characteristics, treatment, and survival of patients with HSCC ( 6 – 8 ). However, other than the TNM staging system, a unified prediction model for HSCC is lacking due to the low prevalence of this disease.…”

“…The outcomes of HSCC are also related to many clinical parameters, such as age (> 70 is an adverse prognostic factor) and primary site (piriform sinus tumor is associated with more favorable outcomes, followed by postcricoid region and then posterior pharyngeal wall) (4,5). Treatment modalities probably affect patient survival, but the conclusions differ across studies (6)(7)(8). However, there is a lack of prognostic scoring systems that take those above clinical factors into account.…”

Prognostic role of human papilloma virus status in hypopharyngeal squamous cell carcinoma

“…However, SEER does include cause of death information that allows us to account for mortality not related to head and neck cancer so we performed a competing risks analysis to account for noncancer mortality. Second, detailed treatment information on chemotherapy and radiotherapy is not available, nor are data regarding comorbidities that may influence treatment selection, thus we cannot interpret our data with respect to HPV status predicting response to treatment though treatment selection has been shown to be of importance in patients with hypopharyngeal cancer 37 . In addition, as discussed above, there may be classification errors (both in exact tumor site and HPV status), which is why we believe our findings ultimately support exploration of testing for both p16 and HPV status to determine the prognostic significance of both of these factors.…”