The Status and Treatment Outcomes in Patients with Hypopharyngeal Cancer: A Nationwide Population-based Study

Background/Objectives: The aim of this national population-based retrospective study was to analyze the status and treatment outcome in patients with hypopharyngeal cancer.Materials & Methods: Participants were included in the KNHIS national sample cohort who received a KNHIS health check-up in 2008 and 2009, and we followed these individuals until 2017. Patients were defined as having hypopharynx cancer if they had admissions records for hypopharynx cancer in their national health insurance data from 2010 to 2017.Results: The study cohort included 3,922 patients. According to our nationwide data, 3,533(90.1%) were male with a median age of 65.03±11.04 years at the time of diagnosis. Among parametric models for hypopharyngeal cancer prognosis, old age (Hazard ratio [HR]:1.92; 95% confidence interval[CI]:1.76-2.09), female (HR:0.77; 95% CI:0.66-0.89), and low socioeconomic status (HR:1.216; 95% CI:1.114-1.327) were significantly associated with survival. Compared with concurrent chemoradiotherapy, patients who received no treatment (HR, 1.88; 95% CI, 1.31-2.70), neoadjuvant chemotherapy followed by surgery (HR, 1.21; 95% CI, 1.04-1.41), and chemotherapy alone (HR, 1.16; 95% CI, 1.03-1.27) showed poor prognosis in hypopharyngeal cancer.Conclusion: Our data indicated that age, sex, and income were significant predictors of lifetime survival in patients with hypopharyngeal cancer. Treatment modalities were also associated with prognosis. The data have implications for treatment investigations and prevention strategies.

ETIOLOGY AND PATHOGENESIS OF HYPOPHARYNX CANCER: GENETIC AND IMMUNOLOGICAL FACTORS OF DEVELOPMENT. Review

Relevance. In the modern oncology hypopharynx malignant tumors are one of the urgent and significant problems. Hypopharynx is one of the most frequent localizations in the head and neck. An important factor causing the high occurrence in the population is the asymptomatic course of the disease, resulting in patients presenting for treatment with аn already widespread tumour process. Objective: to summarize and systematize data on the etiology and pathogenesis of hypopharynx cancer. Materials and methods. Analysis of scientific publications in the international electronic scientometric databases Scopus, PubMed by keywords. Search depth – 20 years (2001-2020). Results. In recent years, the view on the mechanisms of the development of carcinogenesis has changed dramatically, the tumour is no longer considered as a mass of malignant cells, but rather as a self-sufficient biological structure with a complex microenvironment in which other subpopulations of cells damaged by cancer are involved. The stromal component of the tumour microenvironment consists of various types of cells such as cancer-associated fibroblasts, neutrophils, macrophages, regulatory T-cells, myeloid suppressor cells, NK-cells etc. These subpopulations of cells interact with each other as well as with cancer cells. In addition to amplification, deletion, loss of heterozygosity, as well as polymorphism of some genes that are directly involved in the cell cycle or act as regulators of posttranscriptional modifiers of their products at the early stages of carcinogenesis may be one of the promising directions in creating a panel of markers for the risk of developing hypopharynx cancer. Conclusions. The microenvironment of the tumor consists of many different cell populations. These parts of the surrounding stroma can function as both positive and negative regulators of all signs of cancer, including evasion of apoptosis, induction of angiogenesis, deregulation of energy metabolism, resistance to detection and destruction by the immune system, and activation of invasion and metastasis. Exploring differences in the composition of the tumour microenvironment and their influence on the development and progression of hypopharynx cancer can help better understand mechanisms underlying different responses to therapy, and help to identify possible targets for clinical intervention.