Analysis Of Cervical Lymph Node Metastasis And Prognosis Of Hypopharyngeal Carcinoma

Objective Hypopharyngeal carcinoma accounts for 3%-5% of all head and neck cancers.The site of the disease is hidden,and it is prone to cervical lymph node metastasis,and lymph node metastasis is an independent risk factor for the poor prognosis of hypopharyngeal carcinoma.The biological behavior of hypopharyngeal carcinoma is poor,and the early symptoms are not typical.Majority of patients with hypopharyngeal carcinoma are usually diagnosed at an advanced stage.It is particularly important to improve the survival rate of patients while improving the quality of life of patients.Studies have shown that chemotherapy response rate in primary tumor and cervical lymph node is not synchronized.The purpose of this study was to investigate the regulation of cervical lymph node metastasis of hypopharyngeal carcinoma and its influence on the prognosis of the patients,to analyze the effect of induction chemotherapy on the laryngeal function preservation and overall survival of patients in advanced hypopharyngeal carcinoma,to analyse the therapeutic outcomes of lymph nodes that still has no significant effect after induction chemotherapy between up-front node dissection and definitive radiotherapy.Methods1.140 hypopharyngeal squmous cell carcinoma patients were accepted retrospectively.?2 test was adopted for the analysis of the counting data,and kaplan-meier method was used for survival analysis,and the Cox regression model was used to analyze the factors affecting the prognosis.2.313 advanced hypopharyngeal carcinoma cases were retrospectively analyzed.212 patients received induction chemotherapy.The ?2 test was adopted for the analysis of the larynx preservation rate of patients treated with induction chemotherapy combined with radiotherapy or surgery and surgery combined with radiotherapy.The Kaplan-Meier method was used to analyze the survival of the two groups of patients.102 patients had the large cervical lymph nodes that were still ?2cm with primary diseases reached CR or closed to CR after induction chemotherapy.Kaplan-meier method was used for analysis of locoregional control rates of lymph nodes and overall survival rates in up-front node dissection and definitive radiotherapy.Results1.The total rate of lymph node metastasis was 66.4% of the total 140 patients.The rates of hide lymph node metastasis in c N0 patients were 25.0%.The rates of bilateral lymph node metastases were 25%.The most common areas of lymph node metastasis are region II,III,and IV.The total rate of extranodal extension were 66.7%.Univariate analysis showed that cervical lymph node metastasis was closely related to tumor pathological grade(P=0.012),and was not related to gender(P=0.100),age(P=0.100),primary tumor site(P=0.431),tumor T stage(P=0.715).The 3-year and 5-year overall survival rates of patients were 61.0% and 49.1%,respectively.Cox regression analysis showed that the diameter of metastatic lymph nodes(P=0.012),number(P=0.039),and extranodal extension(P=0.010)were significantly related to the survival of patients with hypopharyngeal carcinoma.When the diameter of metastatic lymph nodes ?2.8cm,number?2,with extranodal extension,the prognosis was poor.2.The total response rate of 212 patients received induction chemotherapy in advanced hypopharyngeal carcinoma was 66.1%.The larynx preservation rate of patients in induction chemotherapy combined with radiotherapy or surgery and surgery combined with radiotherapy were 61.5% and 40.6%,respectively(P=0.046),the 3-year survival rates were 37.1% and 33.3%,respectively(P=0.668),5-year survival rates were 35.6% and 8.3%,respectively(P=0.273).In the 102 patients,the 3-year locoregional control rates of the cervical lymph nodes in the up-front node dissection group and definitive radiotherapy group were 44.7% and 17.4%,respectively(P=0.009),the 5-year locoregional control rates of the cervical lymph nodes were 36.4% and 9.1%,respectively(P=0.017),the 3-year overall survival rates in the two group were 50.0% and 32.7%(P=0.055),the 5-year overall survival rates were 45.0% and 20.0%,respectively(P=0.133).Conclusion1.Hypopharyngeal carcinoma has a dismal prognosis,with high rate of lymph node metastasis.Cervical lymph node metastasis is an important factor of the prognosis.The active treatment strategy for the lymph nodes is the key to improve the therapeutic effect of hypopharyngeal carcinoma.2.Induction chemotherapy combined with radiotherapy and surgery can improve the larynx preservation rate in patients with advanced hypopharyngeal carcinoma and improve the quality of life in the patients.When the lymph nodes was large after induction chemotherapy in advanced hypopharyngeal squamous cell carcinoma,up-front node dissection may have better local control of the cervical lymph nodes than definitive radiotherapy.