The presence of risk factors and corresponding treatment strategies post-surgical resection in stage IV hypopharyngeal squamous cell carcinoma patients: a retrospective cohort study

BACKGROUND: This study aims to explore the adverse features and determine whether adjuvant chemoradiation after surgical resection can benefit stage IV hypopharyngeal squamous cell carcinoma (HSCC) patients. METHODS: We conducted a retrospective review covering 267 patients with stage IV HSCC. Propensity score-matched analysis was employed to reduce selection bias. RESULTS: T3–T4 or N2c–N3 stage, positive surgical margin, extracapsular spread and lymphovascular invasion were adverse features for overall survival (OS) in stage IV HSCC patients. For patients possessing these adverse features, those who received postoperative adjuvant treatment (PAT) had significantly better OS and recurrence-free survival (RFS) than patients who did not (P value =0.000 and 0.007, respectively). In addition, adjuvant chemoradiation demonstrated better OS and RFS compared to adjuvant radiation (P value =0.030 and 0.017, respectively). However, PAT showed no significant impact on OS and RFS (P value =0.776 and 0.847, respectively) in patients without adverse features. CONCLUSIONS: Adjuvant treatments are recommended for stage IV HSCC patients that possess adverse features of pT3 and pT4 stages, N2c and N3 stages, positive surgical margin, extracapsular spread and lymphovascular invasion. For these patients, postoperative adjuvant chemoradiotherapy (CRT) is preferred. For patients without adverse features, observation and regular re-examination is sufficient post tumour resection.