Abstract:

Objective To investigate the clinical prognosis and influencing factors of patients with hypopharyngeal squamous cell carcinoma treated by salvage surgery. Methods A total of 78 patients with hypopharyngeal squamous cell carcinoma underwent salvage surgery in Jincheng Second People's Hospital of Shanxi Province from January 2017 to January 2022 were included retrospectively. Postoperative complications were recorded. Logstic regression analysis was used to evaluate the influencing factors of survival after 5 years of salvage surgery， and receiver operating characteristic （ROC） curve was drawn to analyze the predictive value of various influencing factors on the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery. Results The incidence of complications after salvage surgery in 78 patients was 21.79% （17/78）. The median total survival time was 20.5 months. There were 21 deaths 5 years after operation. Univariate analysis showed that the age of salvage surgery （χ²=30.25， P<0.001）， location of recurrent tumor （χ²=8.72， P=0.013）， surgical margin status （χ²=6.93， P=0.008）， depth of tumor invasion （χ²=8.31， P=0.004） and whether to accept radiotherapy （chemotherapy） after salvage operation （χ²=4.24， P=0.040） were all related to the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery. Multivariate analysis showed that the status of the surgical margin （OR=26.26， 95%CI： 4.58-150.62， P<0.001）， the depth of tumor invasion （OR=14.03， 95%CI： 3.04-64.70， P<0.001） and whether to accept radiotherapy （chemotherapy） after the salvage surgery （OR=7.73， 95%CI： 1.68-35.54， P=0.008） were independent factors affecting the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery. The ROC curve analysis showed that the sensitivity of surgical margin status， tumor invasion depth and whether to accept radiotherapy （chemotherapy） after salvage surgery to predict the survival of patients with hypopharyngeal squamous cell carcinoma after 5 years of salvage surgery were 84.15%， 79.60% and 76.43% respectively， and the specificity were 76.03%， 83.51% and 69.46% respectively. The sensitivity and specificity of combined prediction of the three indicators were 92.74% and 77.98% respectively. Conclusion The overall prognosis of hypopharyngeal squanous cell carcinoma patients after salvage surgery is satisfactory. Positive surgical margin， tumor invasion of muscle， bone tissue or lymph node capsule， and no radiotherapy or chemical therapy after salvage surgery are closely related to poor prognosis. Meanwhile， the combination of surgical margin status， tumor invasion and adjuvant treatment after salvage surgery has good efficacy in predicting postoperative survival benefit of patients.

Key words: Hypopharyngeal neoplasms, Surgical procedures, Radiation therapy, Prognosis