SpringerLink
Log in

Comparison of Survival Outcomes Between Larynx-Preserving Open Partial Pharyngectomy and Radiotherapy or Chemoradiotherapy in Patients with Hypopharyngeal Squamous Cell Carcinoma: A Single-Center Retrospective Analysis with Inverse Probability of Treatment Weighting Adjustments

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There is a group of hypopharyngeal squamous cell carcinoma (HPSCC) patients for whom larynx-preserving open partial pharyngectomy (PP) and radiotherapy/chemoradiotherapy (RT/CRT) are indicated. We aimed to retrospectively evaluate the survival difference as there is no evidence directly comparing the two therapies.

Methods

This study evaluated HPSCC patients who were initially treated by PP or RT/CRT at our institution between January 2007 and October 2019. Overall survival (OS), disease-specific survival (DSS), laryngectomy-free survival (LFS), and local relapse-free survival (LRFS) were evaluated. The main analyses were performed with inverse probability of treatment weighting (IPTW) adjustments. Sensitivity analyses compared hazard ratios (HRs) obtained with three models: unadjusted, multivariate Cox regression, and propensity score-adjusted.

Results

Overall, 198 patients were enrolled; 63 and 135 underwent PP and RT/CRT, respectively. IPTW-adjusted 5-year OS, DSS, LFS, and LRFS rates in the PP and RT/CRT groups were 84.3% and 61.9% (p = 0.019), 84.9% and 75.8% (p = 0.168), 94.8% and 90.0% (p = 0.010), and 75.9% and 74.1% (p = 0.789), respectively. In the IPTW-adjusted regression analysis, PP was associated with a significant benefit regarding OS (HR 0.48, 95% confidence interval [CI] 0.26–0.90) and LFS (HR 0.17, 95% CI 0.04–0.77). The results obtained with the three models in the sensitivity analyses were qualitatively similar to those of the IPTW-adjusted models.

Conclusion

Despite the risk of bias related to unadjusted factors, our results suggest that PP is associated with significantly better OS and LFS compared with RT/CRT for HPSCC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Japan Society for Head and Neck Cancer Registry Committee. Report of Head and Neck Cancer Registry of Japan Clinical Statistics of Registered Patients, 2019. 2019. Available at: http://www.jshnc.umin.ne.jp/pdf/HNCreport_2019.pdf. Accessed 16 Aug 2022.

  2. Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91–11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013;31(7):845–52.

    Article  CAS  PubMed  Google Scholar 

  3. McDowell LJ, Rock K, Xu W, et al. Long-term late toxicity, quality of life, and emotional distress in patients with nasopharyngeal carcinoma treated with intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2018;102(2):340–52.

    Article  PubMed  Google Scholar 

  4. Omura G, Saito Y, Ando M, et al. Salvage surgery for local residual or recurrent pharyngeal cancer after radiotherapy or chemoradiotherapy. Laryngoscope. 2014;124(9):2075–80.

    Article  PubMed  Google Scholar 

  5. Ogura JH, Marks JE, Freeman RB. Results of conservation surgery for cancers of the supraglottis and pyriform sinus. Laryngoscope. 1980;90(4):591–600.

    Article  CAS  PubMed  Google Scholar 

  6. Chevalier D, Watelet JB, Darras JA, Piquet JJ. Supraglottic hemilaryngopharyngectomy plus radiation for the treatment of early lateral margin and pyriform sinus carcinoma. Head Neck. 1997;19(1):1–5.

    Article  CAS  PubMed  Google Scholar 

  7. Makeieff M, Mercante G, Jouzdani E, Garrel R, Crampette L, Guerrier B. Supraglottic hemipharyngolaryngectomy for the treatment of T1 and T2 carcinomas of laryngeal margin and piriform sinus. Head Neck. 2004;26(8):701–5.

    Article  PubMed  Google Scholar 

  8. Plouin-Gaudon I, Lengele B, Desuter G, et al. Conservation laryngeal surgery for selected pyriform sinus cancer. Eur J Surg Oncol. 2004;30(10):1123–30.

    Article  CAS  PubMed  Google Scholar 

  9. Laccourreye O, Merite-Drancy A, Brasnu D, et al. Supracricoid hemilaryngopharyngectomy in selected pyriform sinus carcinoma staged as T2. Laryngoscope. 1993;103(12):1373–9.

    Article  CAS  PubMed  Google Scholar 

  10. Bradley PJ, Liu L. Open-neck organ preservation surgery for hypopharyngeal cancer: indications, techniques, limits, and outcomes. Curr Opin Otolaryngol Head Neck Surg. 2019;27(2):123–9.

    Article  PubMed  Google Scholar 

  11. Takes RP, Strojan P, Silver CE, et al. Current trends in initial management of hypopharyngeal cancer: the declining use of open surgery. Head Neck. 2012;34(2):270–81.

    Article  PubMed  Google Scholar 

  12. Hirano S, Tateya I, Kitamura M, et al. Organ preservation surgery for advanced hypopharyngeal cancer. Acta Otolaryngol Suppl. 2010;563:50–5.

    Article  Google Scholar 

  13. Chan JY, Wei WI. Current management strategy of hypopharyngeal carcinoma. Auris Nasus Larynx. 2013;40(1):2–6.

    Article  PubMed  Google Scholar 

  14. Shinozaki T, Hayashi R, Okano W, Tomioka T, Higashino T. Treatment results of 99 patients undergoing open partial hypopharyngectomy with larynx preservation. Jpn J Clin Oncol. 2019;49(10):919–23.

    Article  PubMed  Google Scholar 

  15. Tateya I, Shiotani A, Satou Y, et al. Transoral surgery for laryngo-pharyngeal cancer—the paradigm shift of the head and cancer treatment. Auris Nasus Larynx. 2016;43(1):21–32.

    Article  PubMed  Google Scholar 

  16. Holsinger FC, Ferris RL. Transoral endoscopic head and neck surgery and its role within the multidisciplinary treatment paradigm of oropharynx cancer: robotics, lasers, and clinical trials. J Clin Oncol. 2015;33(29):3285–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Eguchi K, Matsui T, Mukai M, Sugimoto T. Prediction of the depth of invasion in superficial pharyngeal cancer: microvessel morphological evaluation with narrowband imaging. Head Neck. 2019;41(11):3970–5.

    Article  PubMed  Google Scholar 

  18. Kikuchi D, Iizuka T, Yamada A, et al. Utility of magnifying endoscopy with narrow band imaging in determining the invasion depth of superficial pharyngeal cancer. Head Neck. 2015;37(6):846–50.

    Article  PubMed  Google Scholar 

  19. Tateya I, Morita S, Muto M, et al. Magnifying endoscope with NBI to predict the depth of invasion in laryngo-pharyngeal cancer. Laryngoscope. 2015;125(5):1124–9.

    Article  PubMed  Google Scholar 

  20. National Comprehensive Cancer Network. The NCCN Clinical Practice Guidelines in Oncology Head and Neck Cancers (Version 2). Published 20 December 2022. Available at: https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed 11 Dec 2022.

  21. Murakami N, Matsumoto F, Yoshimoto S, et al. Patterns of recurrence after selective postoperative radiation therapy for patients with head and neck squamous cell carcinoma. BMC Cancer. 2016;16:192.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Murakami N, Yoshimoto S, Matsumoto F, et al. Severe gastrointestinal bleeding in patients with locally advanced head and neck squamous cell carcinoma treated by concurrent radiotherapy and Cetuximab. J Cancer Res Clin Oncol. 2015;141(1):177–84.

    Article  CAS  PubMed  Google Scholar 

  23. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70(1):41–55.

    Article  Google Scholar 

  24. Austin PC. The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments. Stat Med. 2014;33(7):1242–58.

    Article  PubMed  Google Scholar 

  25. Cole SR, Hernan MA. Adjusted survival curves with inverse probability weights. Comput Methods Programs Biomed. 2004;7(1):45–9.

    Article  Google Scholar 

  26. Robins JM, Hernán MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology. 2000;11(5):550–60.

    Article  CAS  PubMed  Google Scholar 

  27. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.

    Article  CAS  PubMed  Google Scholar 

  28. Din HA, Zhan KY, Boling C, Nguyen S, Lentsch EJ. Predictors of survival in posterior cricoid squamous cell carcinoma: a study of 248 cases. Laryngoscope. 2017;127(5):1093–6.

    Article  PubMed  Google Scholar 

  29. Kadapa N, Mangale K, Watve P, Rao SLM, Raju AK, Subramanyeshwar Rao T. Postcricoid carcinoma: Is organ preservation justified in T3? Laryngoscope. 2015;125(2):356–9.

    Article  PubMed  Google Scholar 

  30. Grant DG, Salassa JR, Hinni ML, Pearson BW, Hayden RE, Perry WC. Transoral laser microsurgery for recurrent laryngeal and pharyngeal cancer. Otolaryngol Head Neck Surg. 2008;138(5):606–13.

    Article  PubMed  Google Scholar 

  31. Timmermans AJ, van Harten MC, Remmelts AJ, et al. Complications after transoral excision in previously irradiated head and neck cancer patients: our experience in a retrospective cohort study of fifty-two patients. Clin Otolaryngol. 2014;39(4):245–51.

    Article  CAS  PubMed  Google Scholar 

  32. Tomifuji M, Araki K, Yamashita T, Shiotani A. Salvage transoral videolaryngoscopic surgery for radiorecurrent hypopharyngeal and supraglottic cancer. Auris Nasus Larynx. 2017;44(4):464–71.

    Article  PubMed  Google Scholar 

  33. Asakage T, Yokoyama A, Haneda T, et al. Genetic polymorphisms of alcohol and aldehyde dehydrogenases, and drinking, smoking and diet in Japanese men with oral and pharyngeal squamous cell carcinoma. Carcinogenesis. 2007;28(4):865–74.

    Article  CAS  PubMed  Google Scholar 

  34. Pignon JP, Bourhis J, Domenge C, Designé L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-analysis of chemotherapy on head and neck cancer. Lancet. 2000;355(9208):949–55.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number 21K16849. The authors thank Jane Charbonneau, DVM, from Edanz (https://jp.edanz.com/ac), for editing a draft of this manuscript.

Author information

Authors and Affiliations

  1. Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan

    Kohtaro Eguchi MD, PhD, Go Omura MD, PhD, Takane Watanabe MD, Yusuke Aihara MD, Azusa Sakai MD, Yoshifumi Matsumoto MD, PhD, Toshihiko Sakai MD, Kenya Kobayashi MD, PhD & Seiichi Yoshimoto MD, PhD

  2. Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan

    Naoya Murakami MD, PhD & Hiroshi Igaki MD, PhD

  3. Department of Radiation Oncology, Juntendo University, Tokyo, Japan

    Naoya Murakami MD, PhD

  4. Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan

    Yoshitaka Honma MD & Kazuki Yokoyama MD

  5. Department of Otolaryngology, Head and Neck Surgery, The University of Tokyo, Tokyo, Japan

    Kenya Kobayashi MD, PhD

Authors
  1. Kohtaro Eguchi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Go Omura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naoya Murakami MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshitaka Honma MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuki Yokoyama MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takane Watanabe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yusuke Aihara MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Azusa Sakai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yoshifumi Matsumoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Toshihiko Sakai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kenya Kobayashi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hiroshi Igaki MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Seiichi Yoshimoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kohtaro Eguchi MD, PhD.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Eguchi, K., Omura, G., Murakami, N. et al. Comparison of Survival Outcomes Between Larynx-Preserving Open Partial Pharyngectomy and Radiotherapy or Chemoradiotherapy in Patients with Hypopharyngeal Squamous Cell Carcinoma: A Single-Center Retrospective Analysis with Inverse Probability of Treatment Weighting Adjustments. Ann Surg Oncol 30, 6867–6874 (2023). https://doi.org/10.1245/s10434-023-13934-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-023-13934-1

Search

Navigation