Scholarlink

Background <p>The optimal strategy for laryngeal preservation in locally advanced hypopharyngeal carcinoma (LAHPC) remains undefined. This prospective observational study compared long-term outcomes between two primary treatment approaches: induction chemotherapy followed by concurrent chemoradiotherapy (IC-CCRT) and neoadjuvant chemotherapy followed by surgery and adjuvant (chemo)radiotherapy (NAC-Sur-RT).</p> Methods <p>From December 2018 to December 2023, 199 patients with LAHPC were prospectively enrolled and treated with either IC-CCRT (n = 124) or NAC-Sur-RT (n = 75). The primary endpoints were survival with functional larynx (SFL), overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFFS), and distant metastasis-free survival (DMFS). Prognostic factors were identified using multivariable Cox regression.</p> Results <p>In the matched cohort (median follow-up 49&#xa0;months), NAC-Sur-RT was associated with significantly superior 5-year OS (58.3% vs 46.2%; adjusted HR = 0.60; 95% CI 0.38–0.95; P = 0.031) and DMFS (56.2% vs 41.6%; adjusted HR = 0.59; 95% CI 0.38–0.92; P = 0.023), and PFS (52.2% vs 37.2%; adjusted HR = 0.64; 95% CI 0.42–0.98; P = 0.040). Conversely, NAC-Sur-RT was associated with a significantly higher risk of SFL failure (27.0% vs 43.1%; adjusted HR = 2.18; 95% CI 1.45–3.27; P &lt; 0.001). No significant differences were found in LFFS or LRFFS. Failure pattern analysis indicated more isolated local recurrences with IC-CCRT (15.3% vs 5.3%) but higher regional recurrence with NAC-Sur-RT (1.6% vs 6.7%). Multivariable analysis confirmed NAC-Sur-RT as an independent predictor of improved OS (HR = 0.60; P = 0.031), PFS (HR = 0.64; P = 0.040), and DMFS (HR = 0.59; P = 0.023), but also of worse SFL (HR = 2.18; P &lt; 0.001). AJCC stage IVB disease independently predicted inferior OS (HR = 9.05; 95% CI 1.52–53.81; P = 0.015) and DMFS (HR = 8.49; 95% CI 1.53–47.23; P = 0.015). Additionally, NAC-Sur-RT was associated with significantly higher rates of severe (grade 3–4) toxicities, including laryngeal/esophageal, mucosal, hematologic, and functional adverse events.</p> Conclusion <p>In this non-randomized prospective comparison, the NAC-Sur-RT strategy was associated with superior survival outcomes (OS, PFS, DMFS) but at the cost of increased severe toxicity and a significantly lower rate of functional larynx preservation. IC-CCRT offers a higher probability of survival with a functional larynx despite a higher risk of local recurrence. Treatment selection should be individualized, balancing survival benefits, functional outcomes, and toxicity profiles.</p> Trial registration <p>The study was approved by the ethics board of the Chinese PLA General Hospital and registered in the Chinese Clinical Trial Registry (registered number: ChiCTR2000039813).</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Comparison of induction chemotherapy followed by concurrent chemoradiotherapy versus neoadjuvant chemotherapy followed by surgery and (chemo)radiotherapy in locoregionally advanced hypopharyngeal carcinoma: a prospective cohort study

  • 期刊论文

  • 发表日期：

    2026年7月27日

查看全文
  • Da-wei Zhao,
  • Shi-rui Li,
  • Fei Yang,
  • Xiong-fang Guo,
  • Xiao-zhe Sun,
  • Ling Li,
  • Su-cheng Tan,
  • Jin-yang Qin,
  • Ya-jing Qu,
  • Zhong-qiu Wang,
  • Lin Ma,
  • Pei-guo Wang

摘要

Background

The optimal strategy for laryngeal preservation in locally advanced hypopharyngeal carcinoma (LAHPC) remains undefined. This prospective observational study compared long-term outcomes between two primary treatment approaches: induction chemotherapy followed by concurrent chemoradiotherapy (IC-CCRT) and neoadjuvant chemotherapy followed by surgery and adjuvant (chemo)radiotherapy (NAC-Sur-RT).

Methods

From December 2018 to December 2023, 199 patients with LAHPC were prospectively enrolled and treated with either IC-CCRT (n = 124) or NAC-Sur-RT (n = 75). The primary endpoints were survival with functional larynx (SFL), overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFFS), and distant metastasis-free survival (DMFS). Prognostic factors were identified using multivariable Cox regression.

Results

In the matched cohort (median follow-up 49 months), NAC-Sur-RT was associated with significantly superior 5-year OS (58.3% vs 46.2%; adjusted HR = 0.60; 95% CI 0.38–0.95; P = 0.031) and DMFS (56.2% vs 41.6%; adjusted HR = 0.59; 95% CI 0.38–0.92; P = 0.023), and PFS (52.2% vs 37.2%; adjusted HR = 0.64; 95% CI 0.42–0.98; P = 0.040). Conversely, NAC-Sur-RT was associated with a significantly higher risk of SFL failure (27.0% vs 43.1%; adjusted HR = 2.18; 95% CI 1.45–3.27; P < 0.001). No significant differences were found in LFFS or LRFFS. Failure pattern analysis indicated more isolated local recurrences with IC-CCRT (15.3% vs 5.3%) but higher regional recurrence with NAC-Sur-RT (1.6% vs 6.7%). Multivariable analysis confirmed NAC-Sur-RT as an independent predictor of improved OS (HR = 0.60; P = 0.031), PFS (HR = 0.64; P = 0.040), and DMFS (HR = 0.59; P = 0.023), but also of worse SFL (HR = 2.18; P < 0.001). AJCC stage IVB disease independently predicted inferior OS (HR = 9.05; 95% CI 1.52–53.81; P = 0.015) and DMFS (HR = 8.49; 95% CI 1.53–47.23; P = 0.015). Additionally, NAC-Sur-RT was associated with significantly higher rates of severe (grade 3–4) toxicities, including laryngeal/esophageal, mucosal, hematologic, and functional adverse events.

Conclusion

In this non-randomized prospective comparison, the NAC-Sur-RT strategy was associated with superior survival outcomes (OS, PFS, DMFS) but at the cost of increased severe toxicity and a significantly lower rate of functional larynx preservation. IC-CCRT offers a higher probability of survival with a functional larynx despite a higher risk of local recurrence. Treatment selection should be individualized, balancing survival benefits, functional outcomes, and toxicity profiles.

Trial registration

The study was approved by the ethics board of the Chinese PLA General Hospital and registered in the Chinese Clinical Trial Registry (registered number: ChiCTR2000039813).