Evaluating Clinical Outcomes and Predictive Factors of Treatment Approaches in T1-3N3b Hypopharyngeal Carcinoma: Upfront Neck Dissection Versus Concurrent Chemoradiotherapy.

Abstract

This study assessed the efficacy of upfront neck dissection (ND) versus concurrent chemoradiotherapy (CRT) in patients diagnosed with T1-3N3b hypopharyngeal carcinoma (HPC). This retrospective study enrolled patients with T1-3N3b HPC who had undergone upfront ND followed by CRT (upfront group) or CRT (CRT group). Local control rate, neck control rate (NCR), metastasis-free rate, disease-free survival (DFS), disease-specific survival, and overall survival (OS) were compared between the upfront and CRT groups. Univariate and multivariate analyses using Cox proportional hazards models were performed to identify the survival-related clinical factors. Lymph node status and salvage surgery were also analyzed. Forty-eight patients were enrolled in this study, with 18 in the upfront group and 30 in the CRT group. The groups differed significantly in terms of NCR (p = 0.000121) and DFS (p = 0.0256). The lymph node status was found to be a significant prognostic factor for OS in univariate and multivariate analyses. When comparing the upfront, CRT-R (resectable lymph nodes), and CRT-UR (unresectable lymph nodes) groups, significant differences were observed in NCR (p = 0.0005), DFS (p = 0.0123), DSS (p = 0.0312), and OS (p = 0.0159). The upfront group had better outcomes compared to both CRT-R and CRT-UR. In the analysis considering salvage surgery, a significant difference was found in the NCR between the upfront and CRT ± salvage ND groups (p = 0.003). Upfront ND followed by CRT may improve NCR and DFS in patients with stage T1-3N3b HPC compared to CRT. Upfront ND should be considered as a treatment option, provided resectability is feasible.