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OBJECTIVES: Laryngeal and hypopharyngeal cancers treated with total laryngectomy (TL) may provide a unique avenue for COVID-19 to infect cancer patients. The objective of this investigation was to identify incidence of COVID-19 infection and potential complications in TL patients. MATERIALS AND METHODS: Data was extracted from TriNetX COVID-19 research network from from 2019 to 2021 and ICD-10 codes were utilized to query for laryngeal or hypopharyngeal cancer, and outcomes of interest. Cohorts were propensity score-matched based on demographics and co-morbidities. RESULTS: A query of active patients in TriNetX from January 1, 2019 to December 31, 2021 identified 36,414 patients with laryngeal or hypopharyngeal cancer out of the 50,474,648 active patients in the database. The overall COVID-19 incidence in the non-laryngeal or hypopharyngeal cancer population was 10.8% compared to 18.8% (p < 0.001) in the laryngeal and hypopharyngeal cancer group. Those who underwent TL had a statistically significant increased incidence of acquiring COVID-19 (24.0%) when compared to those without TL (17.7%) (p < 0.001). TL patients with COVID-19 had a higher risk of developing pneumonia RR (risk ratio) 1.80 (1.43, 2.26), death 1.74 (1.41, 2.14), ARDS 2.42 (1.16, 5.05), sepsis 1.77 (1.37, 2.29), shock 2.81 (1.88, 4.18), respiratory failure 2.34 (1.90, 2.88), and malnutrition 2.46 (2.01, 3.01) when matched with those COVID-19 positive cancer patients without TL. CONCLUSIONS: Laryngeal and hypopharyngeal cancer patients had a higher rate of acquiring COVID-19 than patients without these cancers. TL patients have a higher rate of COVID-19 compared to those without TL and may be at a higher risk for sequalae of COVID-19.
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COVID-19 , Neoplasias Hipofaríngeas , Neoplasias Laríngeas , Humanos , Laringectomía/efectos adversos , Neoplasias Laríngeas/epidemiología , Neoplasias Laríngeas/cirugía , Neoplasias Hipofaríngeas/epidemiología , Neoplasias Hipofaríngeas/cirugía , Incidencia , Estudios Retrospectivos , COVID-19/epidemiologíaRESUMEN
OBJECTIVES: To explore the prevalence of hypopharyngeal carcinoma (HPC) with synchronous second primary malignancies (Syn-SPMs), their impact on clinical outcomes, and associated risk factors in the image-enhanced endoscopy era. MATERIALS AND METHODS: We retrospectively analyzed 673 patients newly diagnosed with HPC at our cancer center between 2009 and 2019. The patients were divided into three groups: (a) no second primary malignancies (N-SPMs, n = 533); (b) synchronous carcinoma in situ (Syn-Tis, n = 60); (c) synchronous invasive tumors (Syn-invasive, n = 80). Propensity score matching was conducted to balance the N-SPMs and Syn-invasive groups at a 3:1 ratio. RESULTS: Most (96.1%) underwent pretreatment esophagogastroduodenoscopy evaluation with image-enhanced endoscopy. The incidence rates were: Syn-SPMs, 20.8%; Syn-Tis, 8.9%; Syn-invasive, 11.9%. At a median follow-up of 66.7 months, the Syn-Tis and N-SPMs groups had a similar 5-year overall survival (OS; 45.6% vs. 44.5%; hazard ratio [HR], 0.956; 95% confidence interval [CI], 0.660-1.385; p = 0.806). Compared to the N-SPMs group, the Syn-invasive group had poorer 5-year OS (27.0% vs. 52.9%; HR, 2.059; 95% CI, 1.494-2.839; p < 0.001). Alcohol consumption was significantly associated with Syn-SPMs occurrence (odds ratio, 2.055, 2.414, and 3.807 for light, intermediate, and heavy drinkers, respectively). CONCLUSION: The prevalence of Syn-SPMs among patients with HPC was high. Syn-invasive SPMs decreased the survival of patients with HPC. Routine screening with image-enhanced endoscopy should be recommended to detect early-stage SPMs, especially for heavy alcohol drinkers. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:1906-1913, 2023.
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Intoxicación Alcohólica , Carcinoma , Neoplasias Hipofaríngeas , Neoplasias Primarias Múltiples , Neoplasias Primarias Secundarias , Humanos , Neoplasias Primarias Secundarias/diagnóstico , Neoplasias Primarias Secundarias/epidemiología , Neoplasias Primarias Secundarias/etiología , Estudios Retrospectivos , Carcinoma/complicaciones , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/epidemiología , Endoscopía Gastrointestinal , Neoplasias Hipofaríngeas/diagnóstico , Neoplasias Hipofaríngeas/epidemiología , Intoxicación Alcohólica/complicacionesRESUMEN
Objective Patients with advanced hypopharyngeal squamous cell carcinomas (HSCCs) have poor prognoses. The use of surgical or non-surgical treatments for these patients remains a topic of debate. This study compared survival following surgical and non-surgical treatments of patients with advanced HSCC based on the Surveillance, Epidemiology and End Results (SEER) database. Methods Patients diagnosed with hypopharyngeal cancer from 2004 to 2018 were identified from the SEER database. Patients were divided into non-surgical group and surgical group, and patients in the surgical group were further divided into three groups: surgery-only, surgery with adjuvant radiation therapy and surgery with adjuvant chemoradiation therapy. The primary endpoint was overall survival (OS), and the secondary outcome was cancer-specific survival (CSS). Outcomes were analyzed using KaplanMeier analysis. A multivariate Cox regression analysis was also used to identify independent prognostic factors. Results The records of 1568 eligible patients with stage III or IV HSCC were examined. Receipt of surgery was associated with a longer OS [hazard ratio (HR) = 0.47, 95% confidence interval (CI): 0.40.56] and a longer CSS (HR = 0.47, 95% CI: 0.380.57) after adjusting for age, sex, race, tumor site, tumor size, tumor grade, TNM stage, AJCC stage, number of carcinomas, prior cancer, receipt of radiotherapy, and receipt of chemotherapy. The results for OS were similar in an exploratory analysis of different patient subgroups. Conclusion Among patients with advanced HSCC in the SEER database, treatment with surgery was associated with longer OS and CSS than treatment with a non-surgical modality (AU)
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Humanos , Carcinoma de Células Escamosas de Cabeza y Cuello/terapia , Neoplasias Hipofaríngeas/terapia , Carcinoma de Células Escamosas de Cabeza y Cuello/epidemiología , Neoplasias Hipofaríngeas/epidemiología , Resultado del Tratamiento , Quimioradioterapia Adyuvante , Análisis Multivariante , Estadificación de Neoplasias , Programa de VERFRESUMEN
BACKGROUND: To investigate the clinical characteristics of metachronous second primary malignancies (Met-SPMs) and its impact on prognosis in hypopharyngeal carcinoma (HPC). METHODS: We reviewed 593 newly diagnosed HPC patients without invasive synchronous SPMs (Syn-SPMs) who were treated in our cancer center between 2009 and 2019. According to the status during follow-up, patients were classified into three groups: (a) without SPMs (No-SPMs, n = 440), (b) with tumors in situ in the esophagus or stomach (Tis, n = 80), or (c) with Met-SPMs (n = 73). RESULTS: The median follow-up time for entire cohort (n = 593) was 66.7 months. Met-SPMs were present in 12.3% of the cohort (73/593). The predominant site of SPMs was esophagus, followed by lung, oral cavity, thyroid, stomach, and oropharynx. In Met-SPMs group, both index tumor and SPMs were the main causes of death. Tis group exhibited comparable 5-year overall survival (OS) and disease-specific survival (DSS) with that of No-SPMs group. The Met-SPMs group had similar 5-year OS rate and better 5-year DSS rate of 47.3% versus 43.6% (odds ratio [OR], 0.931; 95% confidence interval [CI], 0.681-1.274, p = 0.657) and 66.3% vs. 46.2% (OR, 0.600; 95% CI, 0.402-0.896, p = 0.012), respectively, compared with the No-SPMs group. CONCLUSION: The overall incidence of Met-SPMs in HPC was 12.3%. The occurrence of Met-SPMs does not jeopardize the survival outcome of HPC. Routine surveillance of Met-SPMs was requisite for patients with HPC.
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Carcinoma de Células Escamosas , Neoplasias Hipofaríngeas , Neoplasias Primarias Secundarias , Carcinoma de Células Escamosas/patología , Humanos , Neoplasias Hipofaríngeas/epidemiología , Neoplasias Hipofaríngeas/terapia , Neoplasias Primarias Secundarias/etiología , Prevalencia , Pronóstico , Estudios RetrospectivosRESUMEN
OBJECTIVE: Assess the testing rates and prognostic significance of human papilloma virus (HPV) status in hypopharynx malignancies. STUDY DESIGN: Historical cohort study. SETTING: National Cancer Database. METHODS: Review of the National Cancer Database was conducted between 2010 and 2017 for squamous cell carcinomas (SCCs) of the hypopharynx. We investigated how often the tumors were tested for HPV and whether it was associated with survival outcomes. RESULTS: A total of 13,269 patients with hypopharynx malignancies were identified. Most cases were not tested for HPV status (n = 8702, 65.6%). Of those tested, 872 (19.1%) were positive for HPV and 3695 (80.9%) were negative. The proportion of nonoropharyngeal SCCs tested for HPV increased nearly every year during the study, with roughly one-third of cases (31.9%) being tested in 2017. In the facilities classified as high-testing centers of nonoropharyngeal SCCs of the head and neck, 18.7% of hypopharyngeal tumors were HPV positive. HPV-negative status was associated with worse survival on multivariable analysis. In propensity score-matched analysis controlling for all factors significant in multivariable regression, 2-year survival remained higher in the HPV-positive cohort (77.7% vs 63.1%, P < .001). CONCLUSIONS: HPV-positive tumors constitute a sizable minority of hypopharynx tumors and are associated with improved survival. Expansion of HPV testing to hypopharynx malignancies may be warranted.
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Alphapapillomavirus/aislamiento & purificación , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/virología , Neoplasias Hipofaríngeas/epidemiología , Neoplasias Hipofaríngeas/virología , Infecciones por Papillomavirus/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/diagnóstico , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Neoplasias Hipofaríngeas/diagnóstico , Masculino , Persona de Mediana Edad , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/epidemiología , Pronóstico , Tasa de Supervivencia , Estados UnidosRESUMEN
PURPOSE: Current population-based estimates of the incidence and prognosis of lung metastases of hypopharyngeal cancer are lacking. The purpose of the study is to characterize the incidence proportions and survival probability of patients with hypopharyngeal cancer and lung metastases. MATERIALS AND METHODS: We identified 2714 adult patients diagnosed with hypopharyngeal cancer between 2010 and 2014 for whom the status of lung metastases was known from the SEER database. Multivariable logistic and Cox regression models were performed to identify the risk factors associated with the presence of lung metastases at diagnosis and 5-year all-cause mortality, respectively. RESULTS: We identified 128 patients with lung metastases at the time of diagnosis of hypopharyngeal cancer. Females were less likely to have lung metastases. Incidences of lung metastases were higher among patients with histological grade III/IV. For each 10 mm increase in tumor size, the odds of having lung metastases increased by 6.6%. Patients with lung metastases had a shorter survival time. CONCLUSION: Our study provides insight into the epidemiology of lung metastases in patients with hypopharyngeal cancer. When the tumor is diagnosed, we should pay close attention to the sex, race, tumor size and histological grade to quickly detect the distant metastases.
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Neoplasias Hipofaríngeas , Neoplasias Pulmonares , Adulto , Femenino , Humanos , Neoplasias Hipofaríngeas/epidemiología , Incidencia , Neoplasias Pulmonares/epidemiología , Pronóstico , Modelos de Riesgos ProporcionalesRESUMEN
OBJECTIVES: The primary objective was to determine the prevalence of synchronous esophageal squamous cell carcinoma in head and neck squamous cell carcinoma (HNSCC) patients. The secondary objective was to determine risk factors for the development of synchronous esophageal squamous cell carcinoma (ESCN). STUDY DESIGN: Cross sectional observation study. METHODS: A prospective cross sectional, observational study on consecutive 300 newly diagnosed oral cavity, oropharynx, hypopharynx, and laryngeal squamous cell carcinoma patients who underwent trans-nasal esophageal endoscopy with white light imaging and narrow band imaging. RESULTS: Among 300 patients, index HNSCCs were located in the oral cavity (n = 154, 51.3%), oropharynx (n = 63, 21%), larynx (n = 53, 17.7%), and hypopharynx (n = 30, 10%). The prevalence of synchronous ESCN was 2.7% (n = 8), including four low-grade, two high-grade dysplasia, and two squamous cell carcinomas. On logistic regression analysis, moderate to heavy alcohol consumption (OR 8.7, P = .01) and primary HNSCC involving supraglottis [(OR 12.5, P = .02) were risk factors for synchronous ESCN. The association of pyriform sinus carcinoma and synchronous ESCN was of borderline significance (P = .054, OR 10.92). CONCLUSION: The prevalence of synchronous ESCN in HNSCC was 2.7%. Routine trans-nasal esophagoscopy should be performed in all newly diagnosed patients with carcinoma of the supraglottis and pyriform sinus, and those with consumption of moderate to heavy alcohol for the screening of synchronous ESCN. LEVEL OF EVIDENCE: 2b Laryngoscope, 131:E807-E814, 2021.
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Carcinoma de Células Escamosas/epidemiología , Neoplasias Esofágicas/epidemiología , Carcinoma de Células Escamosas de Esófago/epidemiología , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias Primarias Múltiples/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Esofagoscopía , Femenino , Humanos , Neoplasias Hipofaríngeas/epidemiología , Neoplasias Laríngeas/epidemiología , Laringe/patología , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/epidemiología , Imagen de Banda Estrecha , Neoplasias Orofaríngeas/epidemiología , Prevalencia , Estudios Prospectivos , Seno Piriforme/patología , Adulto JovenRESUMEN
BACKGROUND: Our prospective study of patients with early T-stage head and neck cancer indicated a high incidence of newly diagnosed secondary malignancies during the follow-up period. We aimed to determine the incidence rate and risk factors of secondary malignancies in early-stage head and neck cancer patients. METHODS: We sub-analyzed the patient data of a previous study focusing on secondary cancer incidence. The endpoints were statistical analyses of risk factors and survival and incidence rates. RESULTS: The incidence rate of secondary cancer was 37%, the crude incidence of second primary cancers was 10.6 per 100 person-years, and the 5 year secondary cancer-free survival rate was 63%. The hypopharynx as the primary site was an independent significant predictive factor (odds ratio 3.96, 95% confidence interval 1.07-14.6, p = 0.039). CONCLUSIONS: Early stages of laryngeal, oropharyngeal, and hypopharyngeal cancer had a risk of secondary cancer, especially hypopharyngeal cancer. Attention to the secondary cancer has to be paid during the follow-up period after controlling the early-stage disease. These findings highlight the need for awareness of the incidence of secondary cancer in cases of early-stage primary head and neck cancer.
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Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias Hipofaríngeas , Neoplasias Primarias Secundarias , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Neoplasias Hipofaríngeas/epidemiología , Neoplasias Hipofaríngeas/cirugía , Incidencia , Neoplasias Primarias Secundarias/epidemiología , Estudios ProspectivosRESUMEN
In this retrospective cohort study, we evaluated the incidence of vascular events from carotid artery atherosclerosis after radiotherapy indication for laryngeal and hypopharyngeal cancer. From January 2007 to December 2016, we investigated 111 laryngeal/hypopharyngeal cancer patients who underwent curative radiotherapy and were followed up for ≥1 year (median follow-up duration, 60 months). We evaluated the incidence of vascular events from carotid artery atherosclerosis, defined as a transient ischemic attack or an atherothrombotic cerebral infarction, or from undergoing treatment such as carotid artery stenting for carotid artery stenosis. The median radiation dose was 66 Gy (range, 60-74); 48 patients (43.2%) received concurrent chemotherapy. The 5-year overall survival was 86.2%. Six patients required treatment for carotid artery disease. Carotid stenting was performed in three patients with carotid artery stenosis; three patients developed atherosclerotic cerebral infarction and received medical treatment, with a median of 51.7 months (range, 0.3-78.3) after radiotherapy initiation. The vascular event occurrence rate was 5.4% within 5 years and 10.7% within 8 years. In the univariate analysis, dyslipidemia, diabetes mellitus, and carotid calcification were significant factors for event occurrence. Because three out of six cases occurred out of the irradiated field, no carotid artery or carotid bulb dosimetric parameters showed significant correlation. As laryngeal/hypopharyngeal cancer patients, particularly with complications including dyslipidemia and diabetes mellitus, are at a high risk of carotid artery stenosis after radiotherapy, long-term carotid artery evaluation is necessary. Early intervention by stroke specialists can reduce the risk of fatal cerebral infarction.
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Estenosis Carotídea , Infarto Cerebral , Neoplasias Hipofaríngeas/radioterapia , Ataque Isquémico Transitorio , Radioterapia/efectos adversos , Procedimientos Quirúrgicos Vasculares , Enfermedades de las Arterias Carótidas/diagnóstico , Enfermedades de las Arterias Carótidas/fisiopatología , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/epidemiología , Estenosis Carotídea/etiología , Estenosis Carotídea/cirugía , Infarto Cerebral/etiología , Infarto Cerebral/prevención & control , Femenino , Humanos , Neoplasias Hipofaríngeas/epidemiología , Ataque Isquémico Transitorio/etiología , Ataque Isquémico Transitorio/prevención & control , Japón/epidemiología , Efectos Adversos a Largo Plazo/etiología , Efectos Adversos a Largo Plazo/prevención & control , Masculino , Persona de Mediana Edad , Radioterapia/métodos , Ajuste de Riesgo/métodos , Factores de Riesgo , Stents , Procedimientos Quirúrgicos Vasculares/métodos , Procedimientos Quirúrgicos Vasculares/estadística & datos numéricosRESUMEN
Successful reconstruction after tumor resection facilitates rapid recovery and retention of good quality of life, and this is important for a successful operation. This study aimed to analyze and compare the application and efficacy of xenogeneic acellular dermal matrix (xeno-ADM) and abdominal skin graft in hypopharynx reconstruction.This is a retrospective cohort study that included 25 patients with posterior hypopharyngeal wall cancer who underwent partial hypopharyngectomy with laryngeal preservation. The patients were divided into 2 groups according to the repair materials used. Eleven patients were treated with xeno-ADM, and 14 patients with abdominal skin grafts for repairing hypopharyngeal mucosal defects. The intraoperative data, postoperative recovery time of eating function, graft contraction, infection and pharyngeal fistula rate, and 1-year survival rate of the 2 groups were analyzed and compared.Compared with skin grafts group (23.1â±â5.8 days), the recovery time of eating function in xeno-ADM group was shorter (17.3â±â6.4 days), (Pâ=â.026). Also the number of postoperative hospitalization days were less in the xeno-ADM group (18.5â±â6.7 days) than in the skin grafts group (24.1â±â5.6 days) (Pâ=â.035). Besides, no significant differences were observed in other comparisons between the 2 groups. Also no obvious rejection and severe graft contraction were observed in both the groups. All patients were successfully decannulated.Both xeno-ADM and abdominal skin grafts demonstrated good effects in the reconstruction of hypopharynx, but the recovery time of eating function in patients with xeno-ADM was faster, which may be due to rapid epithelialization. In addition, it avoids trauma of donor sites.
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Dermis Acelular/normas , Neoplasias Hipofaríngeas/cirugía , Complicaciones Posoperatorias/etiología , Adulto , China , Estudios de Cohortes , Femenino , Humanos , Neoplasias Hipofaríngeas/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Trasplante de Piel/métodos , Trasplante de Piel/normasRESUMEN
OBJECTIVE: Firefighters are exposed to a wide variety of carcinogens during the line of duty, including several associated with head and neck cancer. Existing studies assessing head and neck cancer risk with firefighting have predominately included occupational cohorts or registry data, which are limited by inability to adjust for smoking and alcohol consumption-major risk factors for head and neck cancer. Our objective was to assess the risk of head and neck cancer among men with an occupational history as a firefighter. METHODS: This work was conducted using male subjects from a large population-based case-control study of head and neck cancer from the greater Boston area using self-reported occupational history (718 cases and 905 controls). RESULTS: An occupational history as a firefighter was reported for 11 cases and 14 controls. Although no significant association was observed overall, we observed substantial increased risk for hypopharyngeal and laryngeal squamous cell carcinoma among professional municipal firefighters who had a light or no smoking history (OR=8.06, 95% CI 1.74 to 37.41), with significantly increasing risk per decade as a firefighter (OR=2.10, 95% CI 1.06 to 4.14). CONCLUSION: Professional municipal firefighters may be at increased risk for hypopharyngeal and laryngeal squamous cell carcinoma due to carcinogenic exposures encountered during the line of duty.
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Carcinoma de Células Escamosas/epidemiología , Bomberos/estadística & datos numéricos , Neoplasias Hipofaríngeas/epidemiología , Neoplasias Laríngeas/epidemiología , Enfermedades Profesionales/epidemiología , Exposición Profesional/efectos adversos , Adulto , Anciano , Boston/epidemiología , Carcinoma de Células Escamosas/etiología , Carcinoma de Células Escamosas/patología , Estudios de Casos y Controles , Neoplasias de Cabeza y Cuello , Humanos , Neoplasias Hipofaríngeas/etiología , Neoplasias Hipofaríngeas/patología , Neoplasias Laríngeas/etiología , Neoplasias Laríngeas/patología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/etiología , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiologíaRESUMEN
BACKGROUND: Second cancers in patients with esophageal cancer (EC) are common and have a poor prognosis. We evaluated the incidence of second cancers at different sites by patients' ages when their index ECs were diagnosed. METHODS: This study included patients who underwent endoscopic resection for superficial EC at our hospital between September 1994 and September 2011. Patients' data, including sex, age at diagnosis, sequence of cancer incidence, cancer histology, and cancer site, were extracted from the cancer registry. RESULTS: Of 544 patients, 255 developed second cancers. Simultaneous head and neck cancers (HNCs) and other organ cancers (OCs) were, respectively, present in 15% (80/544) and 9.6% (52/544) of patients; and 30% (162/544) developed metachronous second cancers over a median follow-up period of 79.5 months (range 2-120), including 44 metachronous HNCs and 70 OCs. The cumulative incidence of metachronous HNCs was significantly higher in younger patients (< 60 years) than in older patients (≥ 60 years; P = 0.001), whereas the cumulative incidence of OCs was significantly higher in older patients than in younger patients (P = 0.03). CONCLUSIONS: The incidence of second HNC after index EC was higher in younger-onset patients than in older-onset patients. We suggest that younger patients with EC should be carefully monitored for early detection of second HNC.
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Neoplasias Esofágicas/cirugía , Neoplasias Hipofaríngeas/epidemiología , Neoplasias Pulmonares/epidemiología , Neoplasias Primarias Múltiples/epidemiología , Neoplasias Primarias Secundarias/epidemiología , Neoplasias Gástricas/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Endoscopía Gastrointestinal , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Introducción y objetivos: El tratamiento de los pacientes con carcinoma de hipofaringe localmente avanzado incluye la cirugía o combinaciones de radioterapia y quimioterapia realizadas en el contexto de protocolos de preservación de órgano. El objetivo del presente estudio es analizar los resultados obtenidos en pacientes con tumores localmente avanzados de hipofaringe tratados en un centro a lo largo de un periodo de 30 años. Métodos: Estudio retrospectivo de 278 pacientes con tumores de hipofaringe T3-T4 tratados durante el periodo 1985-2015 en un hospital terciario. Resultados: Un 15,5% de los pacientes recibieron tratamiento paliativo, un 38,1% cirugía, habitualmente con radioterapia o quimiorradioterapia postoperatoria, y un 46,4% radioterapia o quimiorradioterapia. La supervivencia específica a los 5 años fue del 39,7% (IC 95% 33,7-45,7). La cirugía consiguió un mejor control local de la enfermedad, si bien este mejor control local no se vio reflejado en una mejoría de la supervivencia específica para los pacientes con tumores T3. La supervivencia a los 5 años libre de disfunción laríngea para los pacientes tratados de forma conservadora fue del 36,4%. De acuerdo con los resultados de un análisis multivariante, las variables que se relacionaron con un empeoramiento de la supervivencia específica fueron la categoría de extensión local T4, de extensión regional N2-N3 y la localización del tumor en la pared posterior de la hipofaringe. Conclusiones: No aparecieron diferencias significativas en función del tipo de tratamiento para los pacientes con tumores de hipofaringe T3. Para los pacientes con tumores T4 la cirugía consiguió un incremento significativo de la supervivencia
Introduction and objectives: The treatment of locally advanced carcinomas of the hypopharynx may include surgery or several combinations of radiotherapy and chemotherapy as organ preservation strategies. The objective of the present study is to analyze the results of locally advanced hypopharyngeal carcinoma patients treated in a single centre over a 30-year period. Methods: Retrospective chart review of 278 patients with T3-T4 hypopharyngeal carcinomas treated between 1985 and 2015 at a tertiary institution. Results: As much as 15.5% of the patients received only palliative treatment. Surgery, usually followed by radiotherapy or chemoradiotherapy was offered to 38.1% of the patients, and radiotherapy or chemoradiotherapy alone was offered to the remaining 46.6% of the patients. Cause-specific survival at 5 years was 39.7% (95% CI 33.7-45.7) for the whole sample. Surgery achieved better local control of the disease, but these figures did not translate into an increase of cause-specific survival for T3 tumours. Five-year survival free of laryngeal dysfunction for patients who received conservative treatment was 36.4%. In a multivariate analysis, only T4 local extension, N2-3 category, and posterior hypopharyngeal wall location related significantly with cause-specific survival. Conclusions: There were no significant differences in cause-specific survival related to treatment modality for T3 carcinomas. On the other hand, surgery achieved a significant increase in cause-specific survival for T4 hypopharyngeal carcinomas
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Carcinoma/epidemiología , Neoplasias Hipofaríngeas/epidemiología , Neoplasias Hipofaríngeas/terapia , Carcinoma/terapia , Estudios Retrospectivos , Hipofaringe/patología , Quimioradioterapia/tendencias , Quimioterapia de Inducción , Protocolos de Quimioterapia Combinada AntineoplásicaRESUMEN
Objectives: To evaluate changes in incidence and survival of patients diagnosed with hypopharyngeal cancer (HPC) in Denmark in the period 1980-2014.Methods: All patients registered with HPC in the Danish Cancer Registry (DCR) in the period 1980-2014 were included. Age-adjusted incidence rates (AAIRs), average annual percentage change in incidence, and overall survival were calculated.Results: Two thousand and nine patients were included (79.7% men). The overall AAIR increased significantly from 0.3 per 100,000 to 1.1 per 100,000 during the study period, corresponding to an increase of 4.1% per year. The most frequent histology was squamous cell carcinoma (SCC) comprising 90.3%. The overall five-year survival increased with 13.5 percentage points from 13.4% in the period 1980-1985 to 26.9% in the period 2010-2014. Women demonstrated better survival compared to men with a hazard ratio of 0.83, and patients with SCC had better survival compared to the remaining histology groups.Conclusions: This nation-wide study, covering nearly four decades, showed a significant increase in incidence and survival of HPC in Denmark.
Asunto(s)
Carcinoma de Células Escamosas/epidemiología , Neoplasias Hipofaríngeas/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Dinamarca/epidemiología , Femenino , Humanos , Neoplasias Hipofaríngeas/mortalidad , Neoplasias Hipofaríngeas/patología , Hipofaringe/patología , Incidencia , Masculino , Persona de Mediana Edad , Seno Piriforme/patología , Factores Sexuales , Análisis de Supervivencia , Tasa de Supervivencia , Factores de TiempoRESUMEN
OBJECTIVES: Human papillomavirus (HPV) can be detected in approximately 25% of squamous cell carcinomas (SCC) of the larynx and hypopharynx. Though HPV is associated with improved survival and disease control in patients with oropharyngeal SCC, the role of HPV as a marker of favorable treatment outcomes in laryngeal and hypopharyngeal cancer is unclear. MATERIALS AND METHODS: Patients treated for laryngeal or hypopharyngeal SCC were reviewed. HPV status detected by p16 and/or HPV DNA PCR were abstracted from the medical record. A subset of samples (stage III-IV treated with primary radiotherapy) was retrospectively tested for p16 and HPV DNA. Overall survival (OS), disease-free survival (DFS), and locoregional control (LRC) were determined and compared between HPV-positive (p16+, PCR+ or both) and HPV-negative (p16- or PCR-) patients. RESULTS: In total, 279 patients were identified, 94 of which were tested for HPV. Eighty-two (87%) were negative and 12 (13%) were positive for HPV. At 3 years, there were no significant differences in OS (72% v. 83%), DFS (60% v. 71%) and LRC (80% v. 89%). Performance status, smoking history and stage predicted for OS, while performance status and stage predicted for DFS. Analysis of patients treated with primary radiotherapy revealed non-significantly higher rates of laryngeal preservation at 3â¯years (75% v. 100%). CONCLUSION: HPV was detected in 13% of tested laryngeal/hypopharyngeal cancers. HPV does not appear to significantly impact survival or disease control in patients with SCC of the larynx or hypopharynx. Non-significant improvements in laryngeal preservation were observed in HPV-positive patients.
Asunto(s)
Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/etiología , Neoplasias Hipofaríngeas/epidemiología , Neoplasias Hipofaríngeas/etiología , Neoplasias Laríngeas/epidemiología , Neoplasias Laríngeas/etiología , Papillomaviridae , Infecciones por Papillomavirus/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Transformación Celular Viral , Susceptibilidad a Enfermedades , Femenino , Humanos , Neoplasias Hipofaríngeas/patología , Estimación de Kaplan-Meier , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Modelos de Riesgos ProporcionalesRESUMEN
BACKGROUND: Several studies have investigated hypopharyngeal cancer (HC) risk in combination with xenobiotic metabolism-related genetic polymorphisms and the burden of alcohol consumption and smoking in European countries but not in East Asian countries. PATIENTS AND METHODS: This hospital-based case-control study involved 61 male patients with HC and 71 male cancer-free controls. Information on age, body mass index, and alcohol and cigarette consumption was obtained from medical records, a self-completion questionnaire, and a thorough interview by an otolaryngologist. Alcohol dehydrogenase 1B (ADH1B), aldehyde dehydrogenase 2 (ALDH2), cytochrome P450 A1 (CYP1A1) MspI, CYP1A1 Ile462Val, glutathione S-transferase (GST) M1, GSTT1, and GSTP1 gene polymorphisms were determined by polymerase chain reaction-based methods. Univariate and multivariate analyses were performed by adjustment for age by the Mantel-Haenszel method. RESULTS: The burden of alcohol and cigarette consumption significantly increased the risk of HC and showed a synergistic effect. ADH1B*1/*1 (odds ratio [OR] 7.34) and ALDH2 *1/*2 (OR 13.22) were significant risk factors for HC. Individuals with ADH1B*1/*1 or ALDH2 *1/*2 who consumed alcohol were more susceptible to HC. However, polymorphisms of CYP1A1 gene and GSTs were not significant cancer risk factors in patients with HC. CONCLUSIONS: ADH1B*1/*1 and ALDH2 *1/*2 were significant risk factors for HC, while polymorphism of CYP1A1 gene and GSTs was not a significant risk factor for HC. These polymorphisms determined the effects of alcohol and cigarette smoke in addition to burden of alcohol and cigarettes intake on the risk of HC.
Asunto(s)
Neoplasias Hipofaríngeas/epidemiología , Neoplasias Hipofaríngeas/etiología , Adulto , Anciano , Alcohol Deshidrogenasa/genética , Alcohol Deshidrogenasa/metabolismo , Consumo de Bebidas Alcohólicas/efectos adversos , Aldehído Deshidrogenasa Mitocondrial/genética , Aldehído Deshidrogenasa Mitocondrial/metabolismo , Carcinógenos , Estudios de Casos y Controles , Etanol/metabolismo , Femenino , Genotipo , Humanos , Neoplasias Hipofaríngeas/metabolismo , Japón/epidemiología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Polimorfismo Genético , Medición de Riesgo , Factores de Riesgo , Fumar/efectos adversosRESUMEN
Hypopharyngeal cancer is uncommon in the developed world; it is mostly diagnosed in men who smoke tobacco and consume excessive alcohol and uncommon in women. However, recent trends in the developed world show that there has been an annual increase in the percentage of women with hypopharyngeal cancer. In France, there has been a significant annual percentage change in the incidence of this form of cancer - a decrease in men and a greater increase in women since the 1980s. In the developing world, India, Taiwan and other countries, the incidence of hypopharyngeal cancer has increased in both men and women. These populations indulge widely in the social habit of tobacco usage at an earlier age, both smoking and chewing, excessive alcohol drinking, along with the chewing of the areca nut. Recent research has proven that areca nut alone is carcinogenic. The combination of tobacco and alcohol has a greater multiplicative impact on increasing the risk of cancer, while the involvement of areca nut remains to be proven. The World Health Organisation has commenced a Global Mission on the cessation of smoking and reduction of alcohol intake. The effect of this work has been credited with a reduction of hypopharyngeal and other head and neck cancers. While the younger aged should be the targeted population to avoid tobacco usage, the middle and older age of the population must be targeted for quitting smoking tobacco.
Asunto(s)
Neoplasias Hipofaríngeas/epidemiología , Adulto , Anciano , Consumo de Bebidas Alcohólicas/efectos adversos , Areca/efectos adversos , Femenino , Salud Global , Humanos , Neoplasias Hipofaríngeas/etiología , Incidencia , Masculino , Persona de Mediana Edad , Sistema de Registros , Factores de Riesgo , Distribución por Sexo , Fumar/efectos adversos , Tabaco sin Humo/efectos adversosRESUMEN
Most cancers occur in developing countries, and therefore, a discussion about cancer care would be incomplete without providing a developing world perspective. This chapter focuses on challenges and practices relating to hypopharyngeal cancer in limited-resource public healthcare systems in developing countries and specifically in Sub-Saharan Africa, India and South America and by extension, most patients in the developing world. Management of hypopharyngeal cancer must be adapted to the availability of specialised diagnostic and therapeutic services, radiotherapy and surgical expertise, and tailored to patient factors such as reliability of follow-up and social support. A particular challenge for physicians is to decide who can be denied the opportunity to be cured when the burden of cancer cases exceeds available resources. Public education campaigns about reducing risk factors for hypopharyngeal cancer are an important aspect of reducing the burden of cancer.
Asunto(s)
Países en Desarrollo , Neoplasias Hipofaríngeas/terapia , África del Sur del Sahara/epidemiología , Asia/epidemiología , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/terapia , Humanos , Neoplasias Hipofaríngeas/epidemiología , Asignación de Recursos , América del Sur/epidemiologíaRESUMEN
OBJECTIVE: To investigate the risk for second primary cancer in the hypopharynx and esophagus (SPC-HE) among individuals with an initial oral/oropharyngeal cancer. MATERIALS AND METHODS: Mass screening data from Taiwan (2004-2009) included individuals who were ≥18 years old and smoked cigarettes and/or chewed betel quid. Occurrence of SPC-HE was monitored until December 31, 2014. Results were expressed as adjusted relative risk (aRR) and 95% confidence interval (CI). RESULTS: One hundred and fifty-eight out of 4,494 subjects with oral cancer developed SPC-HE (incidence rate: 6.47 per 1,000 person-years). Relative to patients with primary cancers in the lip, the risk of an SPC-HE was higher in patients with primary cancers in oropharynx (aRR: 19.98, 95% CI: 4.72-84.55), floor of mouth (aRR: 12.13, 95% CI: 2.67-55.15), and hard palate (aRR: 7.31, 95% CI: 1.65-32.37), but not in patients with cancers in tongue (aRR: 3.67, 95% CI: 0.89-15.17) or gum (aRR: 3.99, 95% CI: 0.92-17.35). Regression analyses also showed the risk of an SPC-HE was greater in alcohol drinkers than those who did not (aRR: 1.65, 95% CI: 1.10-2.48). CONCLUSIONS: Compared with the initial cancer in the lip, patients with a cancer in the oropharynx, floor of mouth, and hard palate had a higher risk for the SPC-HE.
Asunto(s)
Carcinoma de Células Escamosas/epidemiología , Neoplasias Esofágicas/patología , Neoplasias Hipofaríngeas/patología , Neoplasias de la Boca/patología , Neoplasias Primarias Secundarias/patología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Esofágicas/epidemiología , Femenino , Humanos , Neoplasias Hipofaríngeas/epidemiología , Hipofaringe , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/epidemiología , Neoplasias Primarias Secundarias/epidemiología , TaiwánRESUMEN
BACKGROUND: Metachronous cancer in patients with head and neck cancer (HNC) is common and is associated with a poor prognosis. We aimed to evaluate the incidence of metachronous cancer at different sites according to age at diagnosis of index HNC. METHODS: We collected data on 2011 patients with oral cancer, oropharynx cancer, hypopharyngeal cancer, and laryngeal cancer as index cancers using the Osaka International Cancer Institute Cancer Registry database between 2005 and 2016. Among these, we analyzed 1953 patients after excluding 5 patients who were not followed-up and 53 patients with simultaneous multiple index cancers. We evaluated the cumulative incidence of metachronous cancer in the esophagus, lung, and other sites according to age at diagnosis of the index HNC using the Kaplan-Meier method. Multivariate logistic regression analysis was performed to identify factors that influenced the incidence of metachronous cancers following HNC. RESULTS: The cumulative incidence of metachronous esophageal cancer in young patients (< 65 years) was significantly higher than that in old patients (≥ 65 years) (12.1% vs 8.5% at 5 years, and 16.5% vs 11.2% at 10 years; p = 0.015). On the other hand, the cumulative incidence of the other cancers in young patients was significantly lower than that in old patients (7.8% vs 12.2% at 5 years, and 13.9% vs 15.3% at 10 years; p = 0.017). The cumulative incidence of lung cancer was not significance according to age at diagnosis of the index HNC. In the multivariate analysis, histological type (squamous cell carcinoma) and lesion location (hypopharynx and larynx) were independently associated with metachronous cancers. Moreover, age at diagnosis of the index HNC (< 65 years), histological type (squamous cell carcinoma) and lesion location (hypopharynx) were significant predictors of metachronous esophageal cancer incidence and lesion location (hypopharynx) was a significant predictor of metachronous lung cancer incidence. CONCLUSION: Risk stratification of metachronous cancers with age and other predictors may help to properly manage patients with HNC. TRIAL REGISTRATION: The present study is a non-intervention trial.