Treatment sequence and survival in locoregionally advanced hypopharyngeal cancer: A surveillance, epidemiology, and end results-based study

Objectives/hypothesis: The objective of this study was to examine the association between modality of primary treatment and survival among patients with locoregionally advanced hypopharyngeal cancer.

Study design: Retrospective cohort.

Methods: There were 2,328 adult patients diagnosed with stage III or IV, M0, hypopharyngeal squamous cell carcinoma identified within the Surveillance, Epidemiology and End Results (SEER) registry (years 2004-2015). Patients who received primary chemoradiation (CRT) were compared to those who received surgery with either adjuvant radiation therapy (S + RT), or surgery with adjuvant CRT (S + CRT). The latter primary surgery group (S + Adj) was also analyzed collectively. Overall survival (OS) and disease-specific survival (DSS) were assessed using Kaplan-Meier analyses and Cox regression models using a propensity score to adjust for factors associated with treatment allocation.

Results: Median survival was 20 months (interquartile range [IQR] = 10-45) with CRT and 25 months (IQR = 10-47) with S + Adj (P < .001). S + Adj had higher-grade cancers and more advanced T staging (P < .001). S + CRT was associated with longer OS (hazard ratio [HR] = 0.70, 95% confidence interval [CI]: 0.59-0.84) and DSS (HR = 0.66, 95% CI: 0.54-0.82) after adjusting for age, gender, race, subsite, grade, and stage. S + RT was associated with longer DSS than CRT (HR = 0.75, 95% CI: 0.57-0.99) but not OS (HR = 0.82, 95% CI: 0.66-1.04). S + Adj was associated with longer DSS in T1/T2 disease (P = .04) and T4 disease (P = .0003), but did not reach significance among patients with T3 disease (P = .06).

Conclusions: Among patients with advanced hypopharyngeal cancer reported in the SEER database, treatment with S + Adj was associated with longer DSS and OS compared to those treated with primary CRT.

Level of evidence: 2b Laryngoscope, 130:2611-2621, 2020.