| We retrospectively analyzed the clinical records of patients with hypopharyngeal-esophageal double maligancies treated in Sichuan Cancer Hospital and sought to provide singe-center experience on treating these patients.Methods:The clinical data of patients with HPC combined with EC who were treated in Sichuan Caner Hospital from February 2010 to December2016 were collected.According to the criteria proposed by warren et al.[1],the qualified patients were included.The statistical software SPSS 20.0 was used for statistical description and analysis,the survival curve was generated by Kaplan-Meier method,and the cox regression model was used to analyze the prognostic factors of the patients.?was determined as 0.05.P<0.05 was recognized as statistically significant.Results:A total of 86 patients were included in this study,including 67 cases of synchronous double carcinomas and 19 cases of metachronous double carcinomas.The deadline of follow-up was November 2017.Six patients with synchronous double cancers were lost with followup and 80 patients were finally included in the study.The overall follow-up rate was 93%.All tumors were re-staged according to the seventh edition of UICC/AJCC.The median age of 61 patients with synchronous double cancers was 58 years old,of whom only 1 patient was female.55patients were diagnosed as hypopharyngeal carcinoma and esophageal carcinoma at the same time.Five patients were diagnosed with hypopharyngeal carcinoma firstly,with an average interval of 2.6 months?1-4 months?to diagnose esophageal carcinoma.One patient was diagnosed with esophageal carcinoma firstly,with an average interval of 1 month to diagnose hypopharyngeal carcinoma.61 patients with synchronous double cancers were divided into four groups according to different treatment methods.In chemoradiotherpay group,except for 4 early stage EC tumor?Two patients with T1 EC received endoscopic therapy at esophagus plus chemoradiotherapy at pharynx,and two patients with Tis EC received systemic chemotherapy plus chemoradiotherapy at pharynx?,other 24 patients received radiation on both the EC and HPC sites.In the radiotherapy/chemoradiotherapy group,the median dose of gross tumor volume?GTV?of hypopharyngeal carcinoma was 70 Gy,and the median dose of GTV of esophageal carcinoma was 64.5 Gy.In surgery group,9 patients received surgery-based treatment.Among them,1 received surgery alone,and 8 received surgery plus preoperative or postoperative radiotherapy or chemotherapy.In palliative treatment group,17 patients received palliative radiotherapy and chemotherapy?chemotherapy or inadequate radiotherapy?.Among them,9 patients received chemotherapy alone,the other 8 patients received radiotherapy with the GTV dose of esophagus cancer<40 Gy,hypopharyngeal cancer<60Gy.In supportive care group,7patients received only supportive therapy?no radiotherapy,chemotherapy or surgery?.The median overall survival time of 61 patients was 18 months,and the 1-year,2-year and 3-year survival rates were 60.5%,36.7%,and 25.5%respectively.In the supportive care group,the median overall survival time was only 5 months?2-9 months?.In palliative radiotherapy and chemotherapy group,the median overall survival time was 11 months,1,2 and 3-year survival rates were 35.3%,14.7%and 7.4%respectively.In the chemoradiotherapy group and surgery group,the median overall survival time were 24 and 39 months,respectively.1,2 and 3-year survival rates of the two groups were 78.0%,48.6%and 30.9%vs 100%,66.7%,55.6%,respectively.There was no significant difference in survival time between the two groups?P=0.493?.The median PFS of the chemoradiotherapy group and surgery group were 15 vs 22 months,There was no significant difference of PFS between the two groups?P=0.420?.The Cox proportional regression model was used to explore the factors affecting the overall survival rate of patients with synchronous double cancers.The results showed that the treatment strategy and alcohol consumption index had significant impact on overall survival.There was no significant difference on OS between the chemoradiotherapy group and the surgery group of OS?HR=0.788,95%CI?0.291-2.134,P=0.639?,whereas the OS of chemoradiotherapy group was significantly longer than that of another two groups?HR=2.875,95%CI?1.121-7.370,P=0.028;HR=17.129,95%CI?4.288-68.420,P<0.001?.The results also showed that the prognosis of the patients with drinking index>7750 was worse than that of the patients with drinking index?7750?HR=2.116,95%CI?1.078-4.156,P=0.029?.Nineteen patients with metachronous EC-HPC were all male,and the median age was 56years.The median OS was 68 months and the 2-year survival rate was 77.3%.Conclusions:The prognosis of synchronous HPC-EC patients was poor.However,active chemoradiotherpay and surgery achieved better clinical outcome than other conservative treatment.The current study suggested that chemoradiotherpay was equally effective to surgery in treating synchronous HPC-EC.Alcohol consumption index were also an important prognostic factors for patients with synchronous HPC-EC. |
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