[Changing trend in prognosis of primary hypopharyngeal carcinoma and reason analysis: date comparison of 2003-2007 and 2010-2014 in a single centre].

Objective: To explore changing trend in prognosis of primary hypopharyngeal carcinoma and to analyze the reasons at the Eye, Ear, Nose and Throat Hospital of Fudan University. Methods: We retrospectively analyzed the clinical data of 461 patients with primary hypopharyngeal carcinoma treated at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2003 to 2007 (Group 1) and 2010 to 2014 (Group 2) according to the inclusion criteria. 142 from Group 1, including 133 males and 9 females, rangedfrom 38 to 82 years old and 319 from Group 2, including 313 males and 6 females, ranged from 39 to 81 years old, were included in this work. The laryngeal function preservation rate, survival outcome, application and effect of pre-and post-operative adjuvant therapy were compared. SPSS 24.0 was used for statistical analyses. Results: There were 62 patients with early disease (T1-2N0) including 18 in Group 1 and 44 in Group 2, in whom 3 (16.7%) underwent surgical procedures with laryngeal function preservation in Group 1, while, 30 (68.2%) underwent laryngeal function preservation surgery in Group 2. The laryngeal function preservation rate showed an obviously upward trend in recent years (χ(2)=13.617, P<0.001), whereas, the recurrence-free survival rate (RFS) and overall survival rate (OS) showed no significant differences between two groups (P=0.469 and 0.808, respectively). Among the 399 patients with advanced disease, 124 were in Group 1 and 275 in Group 2. After propensity score matching (PSM) was used, the OS rate was significantly higher for Group 2 than Group 1 (P=0.017), while the application of laryngeal function preservation surgery was significantly higher in Group 2 (χ(2)=4.686, P=0.030). The application rates of preoperative adjuvant therapy and postoperative adjuvant chemotherapy were significantly higher in group 2 than in group 1 (χ(2)=5.687, P=0.017; χ(2)=19.407, P<0.001). Conclusion: The application of laryngeal function preserving surgery significantly increases the retention rate of laryngeal functions in patients with early-stage hypopharyngeal carcinoma, with similar long-term survival outcomes. The application of comprehensive treatment including preoperative adjuvant therapy and postoperative adjuvant treatments, especially postoperative chemoradiotherapy, shows an obvious increase in the function preservation rate and long-term survival in patients with advanced hypopharyngeal carcinoma.目的： 探讨复旦大学附属眼耳鼻喉科医院2003—2007年与2010—2014年2个五年间收治的下咽癌患者的生存预后改变趋势，并对其原因进行分析。 方法： 根据相关纳入标准回顾性分析2003年1月至2007年12月（前五年组）及2010年1月至2014年12月（后五年组）期间收治的共461例原发性下咽癌患者的临床资料，其中前五年组收治142例，其中男133例，女9例，年龄38~82岁，后五年组收治319例，其中男313例，女6例，年龄39~81岁。比较2组患者的喉功能保留率、生存率、手术前后辅助治疗的应用及疗效。采用SPSS 24.0软件进行统计学分析。 结果： 2个五年间早期（T1-2N0）患者共62例，其中前五年组18例，后五年组44例；前五年组中接受保喉手术者3例（16.7%），后五年组中接受保喉手术者30例（68.2%），2组喉功能保留率后五年组明显高于前五年组（χ(2)=13.617，P<0.001），且2组治疗后无复发生存率及总体生存率差异无统计学意义（P=0.469、0.808）。2个五年间局部晚期患者共399例，其中前五年组124例，后五年组275例；经倾向评分匹配后分析发现2组间总体生存率后五年组明显优于前五年组（P=0.017）；在局部晚期患者中，后五年组喉功能保留率明显高于前五年组（χ(2)=4.686，P=0.030），且术前辅助治疗和术后辅助放化疗应用率后五年组明显高于前五年组（χ(2)=5.687，P=0.017；χ(2)=19.407，P<0.001）。 结论： 保留喉功能手术方式的应用使得早期下咽癌患者的喉功能保留率明显升高，且仍可收获满意的长期生存情况；综合治疗模式尤其是术前诱导化疗和术后辅助治疗尤其是放化疗的使用使得局部晚期下咽癌患者保喉率及生存预后情况得到显著提高。.