下咽癌合并食管癌双原发癌的临床生存预后分析OA

OBJECTIVE To investigate the clinical characteristics and prognostic factors of patients with hypopharyngeal cancer accompanied by synchronous or metachronous esophageal cancer.METHODS A retrospective analysis was conducted on the clinical data of 90 patients diagnosed with both hypopharyngeal and esophageal cancers,who received treatment at the Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,between January 2010 and April 2023.Based on the diagnostic interval between the two malignancies,patients were stratified into synchronous group(interval≤6 months,n=63)and metachronous group(interval>6 months,n=27).Clinical characteristics were compared between the two groups.Overall survival(OS)was calculated using the Kaplan-Meier method,and prognostic factors were analyzed using the Cox proportional hazards regression model.RESULTS The 1-,3-,and 5-year OS rates were 87.8%,70.3%,and 63.9%,respectively.In the synchronous group,the distribution of hypopharyngeal subsites differed significantly between the two groups(χ²=6.45,P=0.04),with the piriform sinus being the most common in the synchronous group(81.0%,51/63).The median OS was 39 months in the synchronous group and 83 months in the metachronous group.The prognosis of patients in the synchronous group was worse,but the difference was not statistically significant(HR=1.80,P=0.10).Multivariate Cox regression analysis for the metachronous group revealed that an inter-cancer interval of≥3 years was an independent protective factor(HR=0.349,P=0.049),whereas stage IV esophageal cancer was an independent risk factor(HR=3.328,P=0.004).Within the synchronous group,patients who received sequential treatment yielded a significantly higher 5-year OS rate(74.22%)than those who underwent concurrent chemoradiotherapy(20.00%)or extensive surgery(67.57%,P=0.004).CONCLUSION Patients with hypopharyngeal carcinoma have a considerable proportion of coexisting dual primary esophageal malignancies.Consequently,routine endoscopic screening is paramount for early diagnosis.Tailoring individualized therapeutic strategies based on the inter-cancer interval,tumor stage,and treatment sequence is essential to improve long-term prognosis.