TY - JOUR
T1 - Upfront Surgery Versus Upfront Concurrent Chemoradiotherapy as Primary Modality in Hypopharyngeal Squamous Cell Carcinoma
T2 - A Systematic Review and Meta-Analysis
AU - Tsai, Tsung You
AU - Yap, Wing Keen
AU - Wang, Ting Hao
AU - Lu, Yi An
AU - See, Anna
AU - Hu, Yu Feng
AU - Huang, Yenlin
AU - Kao, Huang Kai
AU - Chang, Kai Ping
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Importance: The management of hypopharyngeal squamous cell carcinoma (HPSCC) continues to be one of the most formidable challenges in the realm of head and neck oncology. Objectives: The aim of this meta-analysis was to evaluate the disparity in survival outcomes between upfront surgery and upfront concurrent chemoradiotherapy as the primary treatment modality in patients with HPSCC. Design: Systemic review with meta-analysis. Setting: The meta-analysis was conducted in strict accordance with the PRISMA guideline. A literature search through PubMed, EMBASE, and the Cochrane Library were conducted until January 2023. The adjusted hazard ratio (aHR) with 95% confidence intervals (CIs) of different survival outcomes were extracted and pooled. Participants: Studies that incorporated HPSCC patients without receiving induction chemotherapy. Interventions: Upfront surgery versus upfront concurrent chemoradiotherapy. Main Outcome Measures: Overall survival (OS) and disease-free survival (DFS). Results: Eight studies published between 2015 and 2023, with a pooled patient population of 1619, were included in this meta-analysis. The outcomes reveal that upfront surgery was notably linked with improved OS (aHR 0.66, 95% CI 0.57-0.78) and DFS (aHR 0.75, 95% CI 0.63-0.90). Subgroup analyses were conducted to investigate the impact of the overall stage of the tumor and the extent of surgery on OS. In patients with advanced HPSCC (stages III and IV), upfront surgery remained associated with better OS (aHR 0.65, 95% CI 0.56-0.77). Concerning the extent of surgery, both subgroups exhibited a superior OS outcome associated with upfront surgery (exclusive total laryngopharyngectomy group: aHR 0.54, 95% CI 0.39-0.75; total/partial laryngopharyngectomy group: aHR 0.71, 95% CI 0.59-0.84). Conclusions and Relevance: The results demonstrated that upfront surgery showed better OS and DFS than concurrent chemoradiation and remind the clinicians of the potential reduction in survival outcomes when choosing concurrent chemoradiotherapy as primary treatment.
AB - Importance: The management of hypopharyngeal squamous cell carcinoma (HPSCC) continues to be one of the most formidable challenges in the realm of head and neck oncology. Objectives: The aim of this meta-analysis was to evaluate the disparity in survival outcomes between upfront surgery and upfront concurrent chemoradiotherapy as the primary treatment modality in patients with HPSCC. Design: Systemic review with meta-analysis. Setting: The meta-analysis was conducted in strict accordance with the PRISMA guideline. A literature search through PubMed, EMBASE, and the Cochrane Library were conducted until January 2023. The adjusted hazard ratio (aHR) with 95% confidence intervals (CIs) of different survival outcomes were extracted and pooled. Participants: Studies that incorporated HPSCC patients without receiving induction chemotherapy. Interventions: Upfront surgery versus upfront concurrent chemoradiotherapy. Main Outcome Measures: Overall survival (OS) and disease-free survival (DFS). Results: Eight studies published between 2015 and 2023, with a pooled patient population of 1619, were included in this meta-analysis. The outcomes reveal that upfront surgery was notably linked with improved OS (aHR 0.66, 95% CI 0.57-0.78) and DFS (aHR 0.75, 95% CI 0.63-0.90). Subgroup analyses were conducted to investigate the impact of the overall stage of the tumor and the extent of surgery on OS. In patients with advanced HPSCC (stages III and IV), upfront surgery remained associated with better OS (aHR 0.65, 95% CI 0.56-0.77). Concerning the extent of surgery, both subgroups exhibited a superior OS outcome associated with upfront surgery (exclusive total laryngopharyngectomy group: aHR 0.54, 95% CI 0.39-0.75; total/partial laryngopharyngectomy group: aHR 0.71, 95% CI 0.59-0.84). Conclusions and Relevance: The results demonstrated that upfront surgery showed better OS and DFS than concurrent chemoradiation and remind the clinicians of the potential reduction in survival outcomes when choosing concurrent chemoradiotherapy as primary treatment.
KW - CRT
KW - HPSCC
KW - chemoradiotherapy
KW - hypopharyngeal cancer
KW - squamous cell carcinoma
KW - upfront surgery
UR - https://www.scopus.com/pages/publications/85208081981
U2 - 10.1177/19160216241293633
DO - 10.1177/19160216241293633
M3 - 文章
C2 - 39468833
AN - SCOPUS:85208081981
SN - 1916-0216
VL - 53
JO - Journal of Otolaryngology - Head and Neck Surgery
JF - Journal of Otolaryngology - Head and Neck Surgery
M1 - 19160216241293633
ER -
