| Objective:To summarize and analyze the factors affecting the efficacy and prognosis of non-operative treatment of middle and advanced hypopharyngeal squamous cell carcinoma,so as to provide clinical reference for guiding the treatment of middle and advanced hypopharyngeal squamous cell carcinoma,which has a certain clinical significance.Methods:In this study,retrospective analysis was used to collect and sort out 120 patients with middle and advanced hypopharyngeal squamous cell carcinoma who were treated in Yunnan Cancer Hospital from January 2010 to December 2019.They were divided into 4 groups according to different treatment regimens:there were 38 cases in induction chemotherapy plus radiotherapy group(IC+RT).36 cases in induction chemotherapy+concurrent radiotherapy and chemotherapy group(IC+CCRT),24 cases in induction chemotherapy+radiotherapy+targeted group(IC+RT+targeted),and 22 cases in induced chemotherapy+concurrent radiotherapy+targeted group(IC+CCRT+targeted group).The sex,age,history of tobacco and alcohol,first diagnosed clinical manifestation,location of primary tumor,TNM stage,clinical stage and pathological differentiation were analyzed.HPV DNA expression in all cases was detected by in situ hybridization.In order to determine whether the patient is HPV-related type,and the survival of patients were followed up.Kaplan-Meier method was used to analyze the survival rate and univariate analysis,and Log-rank test was used to compare the curative effects of the four treatment regimens.Cox regression model was used for multivariate analysis to find out the independent factors affecting the prognosis of the patients,that isP<0.05the independent risk factors were statistically significant,and the survival curve was drawn.Results:There were 120 patients with advanced hypopharyngeal squamous cell carcinoma,including 112 males(93.3%)and 8 females(6.7%).The average age was(59.5±8.7)years.71.7%(86 cases)and 50.8%(61 cases)had a history of smoking and drinking respectively.Tumor location:Pyriform fossa carcinoma in 92 cases(82.3%),posterior pharyngeal wall carcinoma in 16 cases(9.4%),posterior cricoid cartilage carcinoma in 12 cases(8.3%);tumor differentiation:well differentiated squamous cell carcinoma in 9 cases(12.2%),moderately differentiated squamous cell carcinoma in 32 cases(43.2%),poorly differentiated squamous cell carcinoma in 33 cases(44.6%).Tumor TNM staging,T staging:T1 23 cases(19.2%),T2 39 cases(32.5%),T3 32 cases(26.7%),T4 26 cases(21.7%);N stage:NO 8 cases(6.7%),N151 cases(42.5%),N2 59 cases(49.2%),N3 2 cases(1.7%),MO 120 cases(100%).Tumor clinical stages,Ⅲ stage 58 cases(48.3%),Ⅳstage 62 cases(51.7%).The expression of HPVDNA was negative in all cases of middle and advanced hypopharyngeal squamous cell carcinoma by in situ hybridization,that is,all cases were HPV-independent hypopharyngeal squamous cell carcinoma.Calculated by Kaplan-Meier method:The overall 1-year,3-year and 5-year OS rates of the patients with middle and advanced hypopharyngeal squamous cell carcinoma were 80%,54.5%and 30.9%,respectively,and the 1-year,3-year and 5-year PFS rates were 78.0%,52.9%and 32.0%,respectively.In IC+RT group,the 1-year,3-year and 5-year OS rates were 76.3%,42.1%and 26.3%,respectively.The 1-year,3-year and 5-year PFS rates were 73.1%,36.8%and 18.7%,respectively.In IC+CCRT group,The 1-year,3-year and 5-year OS rates were 83.3%,65.9%and 48.2%,respectively,and the 1-year,3-year and 5-year PFS rates were 80.6%,60.9%and 41.8%,respectively.The 1-year,3-year and 5-year OS rates in the IC+RT+targeted therapy group were 79.2%,66.2%and 45.6%respectively.The 1-year,3-year and 5-year PFS rates in the targeted group were 79.2%,62.5%and 39.1%,respectively.The 1-year,3-year and 5-year OS rates in theIC+CCR+targeted therapy group were 86.4%,76.5%and 58.8%respectively.The 1-year,3-year and 5-year PFS rates were 86.4%,62.4%and 46.8%,respectively.Univariate analysis showed that treatment method(P=0.023),clinical stage(P=0.015),T stage(P=0.032),N stage(P=0.019),primary location(P=0.000)and pathological differentiation degree(P=0.042)were important factors affecting the prognosis of the patients.The results of univariate analysis showed that the treatment method,clinical stage,T stage,N stage,primary location and pathological differentiation were the important factors affecting the prognosis of the patients.Through Log-rank test:The rates of IC+CCRT OS and PFS were higher than those of IC+RT,the rates of OS of IC+RT+targeted therapy was better than that of IC+RT,the difference of rate of PFS was not statistically significant(0.087),the rate of OS and PFS of IC+CCRT+targeted therapy was better than that of IC+RT,and there was no significant difference between OS rate(0.595)and PFS rate(0.625)between IC+RT+targeted therapy and IC+CCRT.There was no significant difference between IC+CCRT and IC+CCRT+targeted therapy in OS rate(P=0.769)and PFS rate(P=0.704).There was no significant difference in OS rate and PFS rate between IC+RT+targeting and IC+CCRT+targeted therapy.In Ⅲ stage hypopharyngeal squamous cell carcinoma,the OS rate targeted by IC+CCRT,IC+RT+and IC+CCRT+(P=0.036,0.040,0.013,respectively)and PFS rate(P=0.020,0.049,0.014,respectively)were superior to IC+RT.The OS rate(P=0.046,P=0.030)and PFS rate(P=0.049,P=0.018)of IC+CCRT(0.046)and IC+CCRT+targeting(0.030)of hypopharyngeal squamous cell carcinoma in Ⅳ stage were better than those of IC+RT.The multivariate analysis of Cox regression model showed that the treatment regimen(P=0.001)(HR:0.685;95%CI:0.542-0.865),clinical stage(P=0.024)(HR:0.527;95%CI:0.301-0.921),T grade(P=0.012)(HR:1.342;95%CI:1.067-1.688),N grade(P=0.012)(HR:1.737;95%CI:1.129-2.673)and the primary site(P=0.000)(HR:2.001;95%CI:1.469-2.727)were independent risk factors for prognosis.Conclusions:1.In this study,all the patients with middle and advanced hypopharyngeal squamous cell carcinoma were HPV-unrelated;2.In this study,the overall 1-year,3-year and 5-year OS rates of 120 patients with advanced hypopharyngeal squamous cell carcinoma were 80%,54.5%and 30.9%,respectively.The 1-year,3-year and 5-year PFS rates were 78.0%,52.9%and 32.0%,respectively.3.Induction chemotherapy plus simultaneous radiotherapy and chemotherapy can be used as the optimal scheme for middle and advanced hypopharyngeal squamous cell carcinoma.4.Induction chemotherapy+radiotherapy+targeted therapy can be used as an alternative for stage III hypopharyngeal squamous cell carcinoma which cannot tolerate induction chemotherapy and simultaneous radiotherapy and chemotherapy. |
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