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[Postoperative prognostic risk factors and treatment strategies for patients with T3-T4 hypopharyngeal squamous cell carcinoma].

Objective:To investigate the independent prognostic risk factors and the application of different postoperative adjuvant treatment strategies on patients with T3-T4 hypopharyngeal carcinoma. Methods:Based on the inclusion criteria, we conducted a retrospective study that analyzed the clinical data of 229 cases who underwent surgery at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2003 to 2015. Risk factors for postoperative survival were analyzed by univariate and multivariate analysis and patients were stratified according to the independent risk factors. The efficacy of various postoperative adjuvant therapystrategies were compared in different risk groups. Results:Two hundred and twenty-nine patients with T3-T4 primary tumor had 3-year and 5-year overall survival rates of 39.07% and 29.03%, respectively; 3-year and 5-year recurrence-free survival rates were 40.22% and 30.29%, respectively. The results of multivariate analysis demonstrated that tumors in the posterior pharyngeal wall and posterior cricoid region, N2c-N3, lymphovascular invasion, and extranodal extension were independent risk factors. The utility of postoperative adjuvant therapy significantly improved postoperative survival in the high-risk group （P<0.05） and reduced postoperative recurrence significantly （P<0.01）. Patients received adjuvant chemoradiation had better survival than those received adjuvant radiation alone （P<0.05）. Postoperative adjuvant therapy had no significant effect on postoperative survival of patients in the low-risk group. Conclusion:Independent risk factors for patients with T3-T4 hypopharyngeal carcinoma include tumors in the posterior pharyngeal wall and posterior cricoid region, N2c-N3, lymphovascular invasion, as well as extranodal extension. Postoperative adjuvant therapy, especially adjuvant chemoradiation,is recommended for patient with risk factors mentioned above. For patients without those risk factors, postoperative follow-up and re-examination are recommended.