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Purpose <p>To compare treatment patterns and oncologic outcomes of patients with pharyngeal and laryngeal squamous cell carcinoma treated at a&#xa0;tertiary hospital versus three secondary regional hospitals in Franconia, Germany.</p> Methods <p>We retrospectively analyzed 308 consecutive patients (tertiary hospital <i>n</i> = 164; secondary regional hospitals <i>n</i> = 144) diagnosed between 01/2017 and 12/2019 and treated with primary or adjuvant radiotherapy (RT), with or without concomitant chemotherapy. Primary endpoints were overall survival (OS), progression-free survival (PFS), and locoregional recurrence-free survival (LRRFS). Kaplan-Meier estimates, multivariable Cox regression models, and a&#xa0;1:1 matched-pair analysis were applied. Residual confounding was quantified using E‑values.</p> Results <p>The cohorts were well balanced, except for a&#xa0;higher prevalence of HPV-negative tumors (52% vs 42%, <i>p</i> = 0.004) and ECOG performance status &gt; 1 (20% vs 9%, <i>p</i> = 0.004) in secondary hospitals. Median follow-up was 34&#xa0;months. OS (median 35.5 vs 32&#xa0;months; HR 0.90, 95% CI 0.72–1.12) and PFS (29 vs 21.5 months; HR 0.86, 95% CI 0.69–1.07) did not differ significantly between groups. LRRFS was shorter in secondary hospitals (32 vs 25.5 months; HR&#xa0;1.25, 95% CI 1.06–1.48; <i>p</i> = 0.05), which may partly be explained by the higher rate of HPV-negative tumors in this cohort. Sensitivity analyses indicated that residual confounding may still have contributed to this difference. Multivariable analysis identified ECOG &gt; 1 (HR 3.29), HPV negativity (HR 2.56), R2 resection status (HR 16.1 for PFS), and a&#xa0;cumulative cisplatin dose &lt; 160 mg/m<sup>2</sup> (HR &gt; 3) as independent prognostic factors.</p> Conclusion <p>Radiotherapy for pharyngeal and laryngeal cancer achieved comparable OS and PFS in tertiary and secondary hospitals that adhere to current quality benchmarks. The observed difference in locoregional control, which was limited to the primary (non-surgical) cohort, is consistent with the higher proportion of HPV-negative and functionally impaired patients treated in secondary hospitals. Residual imbalance after adjustment and matching indicates that unmeasured clinical or treatment-related factors may also contribute. Prompt initiation of RT and adequate cumulative cisplatin dosing remain critical.</p>

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Multicentre patterns-of-care analysis of adjuvant and definitive (chemo)radiotherapy for pharyngeal and laryngeal carcinoma in Franconia, Germany

  • 期刊论文

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  • 发表日期：

    2026年5月11日

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  • Karoline Pollmann,
  • Adriana Salazar Hammann,
  • Jochen Willner,
  • Reinhart Sweeney,
  • Stefan Münch,
  • Thomas Gehrke,
  • Michael Flentje,
  • Andrea Wittig-Sauerwein,
  • Victor Lewitzki

摘要

Purpose

To compare treatment patterns and oncologic outcomes of patients with pharyngeal and laryngeal squamous cell carcinoma treated at a tertiary hospital versus three secondary regional hospitals in Franconia, Germany.

Methods

We retrospectively analyzed 308 consecutive patients (tertiary hospital n = 164; secondary regional hospitals n = 144) diagnosed between 01/2017 and 12/2019 and treated with primary or adjuvant radiotherapy (RT), with or without concomitant chemotherapy. Primary endpoints were overall survival (OS), progression-free survival (PFS), and locoregional recurrence-free survival (LRRFS). Kaplan-Meier estimates, multivariable Cox regression models, and a 1:1 matched-pair analysis were applied. Residual confounding was quantified using E‑values.

Results

The cohorts were well balanced, except for a higher prevalence of HPV-negative tumors (52% vs 42%, p = 0.004) and ECOG performance status > 1 (20% vs 9%, p = 0.004) in secondary hospitals. Median follow-up was 34 months. OS (median 35.5 vs 32 months; HR 0.90, 95% CI 0.72–1.12) and PFS (29 vs 21.5 months; HR 0.86, 95% CI 0.69–1.07) did not differ significantly between groups. LRRFS was shorter in secondary hospitals (32 vs 25.5 months; HR 1.25, 95% CI 1.06–1.48; p = 0.05), which may partly be explained by the higher rate of HPV-negative tumors in this cohort. Sensitivity analyses indicated that residual confounding may still have contributed to this difference. Multivariable analysis identified ECOG > 1 (HR 3.29), HPV negativity (HR 2.56), R2 resection status (HR 16.1 for PFS), and a cumulative cisplatin dose < 160 mg/m2 (HR > 3) as independent prognostic factors.

Conclusion

Radiotherapy for pharyngeal and laryngeal cancer achieved comparable OS and PFS in tertiary and secondary hospitals that adhere to current quality benchmarks. The observed difference in locoregional control, which was limited to the primary (non-surgical) cohort, is consistent with the higher proportion of HPV-negative and functionally impaired patients treated in secondary hospitals. Residual imbalance after adjustment and matching indicates that unmeasured clinical or treatment-related factors may also contribute. Prompt initiation of RT and adequate cumulative cisplatin dosing remain critical.