Survival Benefit of Adjuvant Radiotherapy After Surgery in Patients With T1 ‐ 2N1M0 Hypopharyngeal Squamous Cell Carcinoma: A Dual‐Cohort Analysis of SEER and Institutional Data

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Abstract
Background: The optimal therapeutic strategy for patients with T2‐3N0‐3 M0 or T1N1‐3 M0 hypopharyngeal squamous cell carcinoma (HPSCC) and the use of postoperative radiotherapy with or without systemic therapy for patients with T1‐2N1M0 HPSCC remain controversial. We aimed to determine whether these additional treatments improve the prognosis in HPSCC. Methods: We retrospectively analyzed the databases held by the SEER (surveillance, epidemiology, and end results) program and a tertiary referral center in China to evaluate the survival outcomes of surgical intervention for T2‐3N0‐3 M0 and T1N1‐3 M0 HPSCC and of postoperative radiotherapy for T1‐2N1M0 disease. Results: The SEER contained data for 1235 patients with T2‐3N0‐3 M0 or T1N1‐3 M0 HPSCC, of whom 220 underwent surgery as their first treatment and 737 received non‐surgical treatment. There was no statistically significant difference in overall survival (OS) between these two groups. Data were also available for 30 patients in the SEER who were treated by surgery alone ( n = 11), surgery plus postoperative radiotherapy ( n = 7), or surgery plus postoperative radiotherapy with systemic therapy ( n = 12). Similarly, 23 patients at our hospital were identified to have been treated by surgery alone ( n = 7), surgery plus postoperative radiotherapy ( n = 10), or surgery plus postoperative radiotherapy with systemic therapy ( n = 6). The SEER data indicated that postoperative radiotherapy improved OS (hazard ratio 0.281, 95% confidence interval 0.079–0.998; p = 0.036). This finding was supported by the data from our hospital, although the improvement in OS was not statistically significant (hazard ratio 0.360, 95% confidence interval 0.057–2.261; p = 0.224). Postoperative radiotherapy with systemic therapy seemed not to improve OS beyond that achieved by postoperative radiotherapy alone. Conclusions: There was no significant difference in OS in patients with T2‐3N0‐3 M0 or T1N1‐3 M0 HPSCC according to whether or not they underwent surgery as first‐line treatment. Surgery plus postoperative radiotherapy was associated with a more favorable prognosis than surgery alone in patients with T1‐2N1M0 HPSCC.
Funding Information
  • National Natural Science Foundation of China (82403372)
  • Basic and Applied Basic Research Foundation of Guangdong Province (2022A1515110147)
  • China Postdoctoral Science Foundation (2021M703712)
  • National Key Research and Development Program of China (2020YFC1316903)

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