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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Hypopharyngeal cancer trends in a high-incidence region: A retrospective tertiary single center study
Alina-Georgiana Vulcu Cordunianu, Gabriel Ganea, Mihai Alexandru Cordunianu, Daniel Cochior, Cosmin Alec Moldovan, Razvan Adam
Alina-Georgiana Vulcu Cordunianu, Mihai Alexandru Cordunianu, Doctoral School of Medicine, Titu Maiorescu University of Bucharest, Bucharest 040317, Romania
Alina-Georgiana Vulcu Cordunianu, Gabriel Ganea, Department of Ear Nose Throat Head and Neck Surgery, Carol Davila Central University Emergency Military Hospital, Bucharest 10825, Romania
Mihai Alexandru Cordunianu, Department of Pediatric Orthopedics, Victor Gomoiu Hospital, Bucharest 022102, Romania
Daniel Cochior, Cosmin Alec Moldovan, Razvan Adam, Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University, Bucharest 031593, Romania
Daniel Cochior, Department of General Surgery, Sanador Clinical Hospital, Bucharest 010991, Romania
Daniel Cochior, Department of General Surgery, Monza Clinical Hospital, Bucharest 021967, Romania
Cosmin Alec Moldovan, Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, Romania
Razvan Adam, Department of Orthopedics and Traumatology, Elias Emergency University Hospital, Bucharest 011461, Romania
Author contributions: Cordunianu AGV and Cochior D made the design and concept of the present study; Ganea G and Cordunianu AGV aquired the patient data and cofirmed authenticity of all raw data; Moldovan CA and Adam R performed data analysis and literature review; Cordunianu AGV and Moldovan CA drafted the initial manuscript; Cochior D and Moldovan CA revised the final manuscript; Cochior D critically revised the manuscript for intellectual content; All authors have read and approved the final manuscript.
Institutional review board statement: This study was authorized by the Ethics Committee of Titu Maiorescu Doctoral School (Bucharest, Romania) number 15/2022 and by the Ethics Committee of Carol Davila Central University Emergency Military Hospital (Bucharest, Romania) number 538/2022.
Informed consent statement: All patients provided written informed consent for data usage and publication in research purposes.
Conflict-of-interest statement: The authors declare no conflict-of-interest.
Data sharing statement: The data used and analyzed in this study are available from the corresponding author on reasonable request at cosmin.moldovan@prof.utm.ro.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Cosmin Alec Moldovan, MD, PhD, Associate Professor, Department of Medical-Surgical and Prophylactic Disciplines, Faculty of Medicine, Titu Maiorescu University, Gheorghe Petrascu 67A Street, 3rd District, Bucharest 031593, Romania. cosmin.moldovan@prof.utm.ro
Received: April 2, 2023
Peer-review started: April 2, 2023
First decision: May 31, 2023
Revised: June 11, 2023
Accepted: July 31, 2023
Article in press: July 31, 2023
Published online: August 26, 2023
BACKGROUND
Hypopharyngeal cancer has the bleakest prognosis among head and neck cancers due to its extensive submucosal involvement, advanced tumor stage, and limited surgical reconstruction options. Its primary causes include alcohol consumption, tobacco use, genetic predisposition, 1` diet, and socioeconomic conditions. While squamous cell carcinoma (SCC) accounts for 95% of hypopharyngeal tumors, it remains a rare form, comprising only 3%-5% of all SCC cases in the head and neck region. Globally, Central and Eastern Europe have the highest incidence rates for males (3.9 per 100000) and the third highest for females (2.26 per 100000), underscoring the significance of this seemingly uncommon condition. In Romania, hypopharyngeal cancer ranked 24th in incidence rate, with 634 new cases in 2020.
AIM
To study the incidence, treatment and survival rates of hypopharyngeal tumor cases in a major ear, nose, throat (ENT) surgical center.
METHODS
A retrospective epidemiological clinical study was conducted on patients diagnosed and treated for hypopharyngeal cancer at the ENT department of "Carol Davila Central University Emergency Military Hospital" in Bucharest between January 2018 and August 2022. The study included 53 patients and was authorized by the Ethics Committee of Titu Maiorescu Doctoral School (Bucharest, Romania) and the Ethics Committee of Carol Davila Central University Emergency Military Hospital (Bucharest, Romania). Inclusion criteria required a positive histopathological diagnosis of hypopharyngeal cancer, tumor localization in the hypopharyngeal region, and informed consent for data usage. Exclusion criteria involved major psychiatric pathologies and disagreement for data usage. Diagnosis was based on ENT assessment, imaging reports, and laboratory data. Treatment methods were determined based on various factors. Additional tools, such as Adult Comorbidity Evaluation-27 and Karnofski Performance Status Scale, were used for risk assessment and functional capacity evaluation. Quality of life aspects were measured using the European Organisation for Reasearch and Treatment of Cancer Quality of Life Questionnaire Head and Neck-35 questionnaire.
RESULTS
Our retrospective study examined 53 patients with hypopharyngeal cancer between January 2018 and August 2022. The majority of patients were male (94.3%), with an average age at diagnosis of 62.5 years. Among the patients, 20.75% were employed, 66.03% were retired, and 9.43% were unemployed. Smoking was prevalent among 69.81% of patients, while alcohol consumption was frequent in 32.07% of cases. The tumors were mostly diagnosed at an advanced stage (stage IV) and were predominantly SCC. Comorbidities were present in 83.01% of patients, with cardiovascular diseases being the most common. Dysphagia and neck mass were the most common symptoms reported. Treatment methods included surgery, radiation therapy, and chemotherapy. A favorable treatment response was observed in 22.64% of cases, while relapse occurred in 6 cases. Follow-up data was unavailable for some patients.
CONCLUSION
In summary, our findings align with existing literature; however, we observed a higher severity.
Core Tip: This retrospective study analyzed 53 hypopharyngeal cancer patients' data, focusing on diagnostic methods, treatment strategies, and quality-of-life assessments using Adult Comorbidity Evaluation-27, Karnofski Performance Status Scale, and European Organisation for Reasearch and Treatment of Cancer Quality of Life Questionnaire Head and Neck-35. Our findings discovered that most patients had advanced stage cancer, frequent smoking history, and comorbidities. Various treatments were applied, with mixed responses and a 30.18% follow-up rate. Late-stage diagnosis resulted in decreased capacity function; 83% had comorbidities. Organ conservation therapies were preferred by 43.39%, driven by similar survival rates and quality of life considerations. In conclusion, all the data we found was similar to the one found in literature, but with a higher degree of severity and a younger age at diagnosis compared to the most studies.
