Clinicopathologic aspects of locoregional recurrence of hypopharyngeal cancer and their implication on the survival of patients / 中华耳鼻咽喉头颈外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the clinicopathologic aspects of locoregional recurrence and their implication on the survival in patients with hypopharyngeal cancer.</p><p><b>METHODS</b>A retrospective review of 101 patients with hypopharyngeal cancer that were treated with surgical management and postoperative radiotherapy from 1998 to 2004 was performed. The clinicopathologic risk factors for locoregional recurrence were evaluated by using univariate chi(2) tests and multiple stepwise Logistic regression models. Survival analysis was performed by using Kaplan-Meier method, Log-Rank test and Cox proportional hazard model.</p><p><b>RESULTS</b>The overall incidence of locoregional recurrence in this series of hypopharyngeal cancer was 43.6% (44/101). The rates of recurrence were local 13.9% (14/101), regional 31.7% (32/101). In a multivariate Logistic regression analysis, it was confirmed that number of levels with pathologic lymph node (OR = 0.334, P = 0.0242) was the most significant risk factors for locoregional recurrence. The same for regional recurrence was capsule rupture of pathologic lymph node (OR = 0.353, P = 0.0389) and multilevel positive nodal involvement in neck (OR = 0.259, P = 0.0069). The overall survival of hypopharyngeal cancer was 23.2%, and reduced to 11.4% for locoregional recurrence. The recurrences were managed by salvage surgery in 12 cases, which included local recurrences after partial pharyngolaryngectomy, ipsilateral regional recurrences after selective neck dissection, and contralateral regional recurrences at initially uninvolved neck. The overall survival of those patients sustained 33.3%. A multivariate Cox regression analysis revealed that the factors impacting the prognosis were recurrent time (RR = 0.317, P < 0.0001) and treatment modality after locoregional recurrence (RR = 6.119, P = 0.0001).</p><p><b>CONCLUSIONS</b>Locoregional recurrences are frequent and have a very negative impact on patient survival in hypopharyngeal cancer, which most commonly have a regional recurrence. Salvage surgery in suitable cases seems to improve survival rates. Much attention should be paid to cervical pathological factors for locoregional recurrences in hypopharyngeal cancer, especially multilevel and capsule rupture of pathologic lymph node.</p>