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Risk stratification of postoperative recurrence in hypopharyngeal squamous-cell carcinoma patients with nodal metastasis

  • Original Article – Clinical Oncology
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To explore lymph node-related risk factors and investigate the benefit of different adjuvant therapy strategies in hypopharyngeal squamous-cell carcinoma (HPSCC) patients with nodal metastasis (N +).


We conducted a retrospective review covering 266 HPSCC patients with nodal metastasis. Kaplan–Meier curves and Cox proportional hazard models were utilized to evaluate recurrence-free survival (RFS) and independent risk factors.


pT3-T4, extranodal extension, lymphovascular invasion, and lower lymph node involvement were high-risk factors leading to poorer RFS in N + HPSCC patients. Patients were classified into three groups based on the recursive-partitioning analysis (RPA). Postoperative chemoradiation significantly improved RFS in patients in the high-risk group (p < 0.001). For patients in the low- and intermediate-risk groups, the application of adjuvant therapies showed no significant benefit on RFS (p = 0.74 and 0.53, respectively).


The novel risk stratification for N + HPSCC patients can predict the risk of postoperative recurrence effectively. Adjuvant chemoradiation is preferred for patients in the high-risk group as it lowers risk of recurrence. Conversely, for patients in the low- and intermediate-risk groups, regular observation and follow-up strategies are a valid form of treatment.

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The study was supported by the Science and Technology Innovation Project of Shanghai Shen-kang Hospital Clinical Development Center under Grand (SHDC12015114); the Science and Technology Commission of Shanghai Municipality under Grand (16411950100); the National Natural Science Foundation of China under Grand (81772878, 30801283, 30972691); the Shanghai Science and Technology Development Funds under Grand (09QA1401000, 10QA1405900, 14411961900); the Training Program of the Excellent Young Talents of Shanghai Municipal Health System under Grand (XYQ2011055, XYQ2011015); and the Shanghai Municipal Science and Technology Foundation under Grand (11JC1410802).

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Authors and Affiliations



Study concepts: HQL, TW and LT. Study design: HQL, PYC and LT. Data acquisition: LZ, MZ and YS. Data analysis and interpretation: HQL, YH and XKZ. Statistical analysis: HQL and TW. Manuscript preparation: HQL, TW and LT. Manuscript editing: HQL, TW. Manuscript review: PYC, LT. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Pengyu Cao or Lei Tao.

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The authors declare that they have no competing interests.

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This study was approved by the Institutional Ethics Committee of the Eye & ENT Hospital of Fudan University.

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All participants gave informed consent to take part in the study.

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Lin, H., Wang, T., Heng, Y. et al. Risk stratification of postoperative recurrence in hypopharyngeal squamous-cell carcinoma patients with nodal metastasis. J Cancer Res Clin Oncol 147, 803–811 (2021).

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