早期下咽癌（T1-2N0M0）的根治性放疗：临床结局与预后因素的回顾性研究。

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中文摘要

背景： 下咽癌（HPC）是一种侵袭性恶性肿瘤，常在晚期才被诊断。窄带成像技术的进步提高了下咽癌的早期检出率。根治性放疗（RT）是一种无创、保留器官的治疗选择，推荐用于早期（T1-2N0M0）疾病；然而，其临床结局仍然有限。本研究回顾性评估了根治性放疗用于早期下咽癌的临床结局。方法：我们回顾性分析了2013年至2023年间接受放疗的55例早期下咽癌患者。治疗包括容积旋转调强放疗或三维适形放疗，并选择性淋巴结照射。对部分T2期患者给予放化疗。采用Kaplan-Meier和Cox模型评估生存结局。结果：中位随访时间为43个月。5年总生存（OS）率、无进展生存率和癌症特异性生存率分别为65%、57%和82%。5年局部控制率、局部区域控制率和喉保留率分别为79%、74%和91%。初始复发为局部区域复发，其中55例患者中10例（18%）出现局部复发，55例中3例（5.4%）出现区域淋巴结复发。在单变量分析中，年龄较大（≧71岁）和食管癌病史与显著更差的OS相关。多变量分析证实，年龄较大和食管癌病史是OS的独立预测因素。结论：放疗用于早期下咽癌可提供良好的肿瘤学结局和高喉保留率。然而，OS受年龄和食管癌病史的强烈影响，这凸显了治疗选择和随访的必要性，包括对第二原发食管癌的监测。

英文摘要

Hypopharyngeal carcinoma (HPC) is an aggressive malignancy that is often diagnosed at an advanced stage. Advances in narrowband imaging have increased the early detection rate of HPC. Definitive radiotherapy (RT) is a noninvasive, organ-preserving option recommended for early stage (T1-2N0M0) disease; however, its clinical outcomes remain limited. This study retrospectively evaluated the clinical outcomes of definitive RT for early stage HPC. We retrospectively analyzed 55 patients with early stage HPC who were treated with RT between 2013 and 2023. Treatments included volumetric-modulated arc therapy or three-dimensional conformal radiotherapy with elective nodal irradiation. Chemoradiotherapy was administered to selected patients with stage T2 disease. Survival outcomes were assessed using Kaplan-Meier and Cox models. Median follow-up was 43 months. The 5-year overall survival (OS), progression-free survival, and cancer-specific survival rates were 65%, 57%, and 82%, respectively. Local control, locoregional control and laryngeal preservation rate at 5 years were 79%, 74%, and 91%, respectively. Initial recurrences were locoregional, with local recurrence in 10 of 55 patients (18%) and regional lymph node recurrence in three of 55 patients (5.4%). In univariate analysis, older age (≧71 years) and a history of esophageal cancer were associated with significantly worse OS. The multivariate analysis confirmed that older age and a history of esophageal cancer were independent predictors of OS. RT for early stage HPC provides favorable oncological outcomes and high rates of laryngeal preservation. However, OS was strongly influenced by age and a history of esophageal cancer, highlighting the need for treatment selection and follow-up, including surveillance for second primary esophageal cancer.