Ru Wang,1,* Ahmad A Hariri,2,* Hengmin Tao,1 Yumei Wei,1 Zhenghua Lyu3 

1Department of Head and Neck Radiotherapy, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, People’s Republic of China; 2Department of Otolaryngology-Head and Neck Surgery, London North West University Healthcare NHS Trust, London, England, UK; 3Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yumei Wei, Email 15553119268@163.com Zhenghua Lyu, Email entlvzhenghua@163.com

Objective: To summarize the efficacy of surgery plus postoperative radiotherapy as initial treatment in elderly patients aged ≥ 70 years with advanced hypopharyngeal cancer and to analyze prognostic factors.
Methods: Retrospective analysis of 77 elderly patients aged ≥ 70 years with stage III–IV hypopharyngeal squamous cell carcinoma who underwent surgery as initial treatment at Shandong Provincial ENT Hospital between 2006– 2020. Treatment completion rate and prognostic factors were summarized and analyzed, with comparisons made to non-surgical treatments in published literature. SPSS 26.0 was used for analysis. Univariate Cox regression analysis was applied to identify potential predictors of overall survival (OS) and disease-free survival (DFS). Kaplan–Meier method with Log rank test was used to calculate and compare survival rates. Multivariate analysis employed the Cox proportional hazards regression model, with P < 0.05 considered statistically significant.
Results: The study achieved 100% follow-up with a median duration of 62 months. Among the cohort, 26 patients received surgery only whilst 51 received surgery plus radiotherapy, seven patients failed to complete radiotherapy resulting in a completion rate of 86.27%. Survival analysis revealed significant intergroup differences: at 1 year, OS/DFS rates were 76.9%/73.1% in Group A versus 93.2%/81.8% in Group B (both P < 0.05). By 3 years, OS/DFS rates were 61.5%/57.7% in Group A versus 77.3%/70.5% in Group B. The overall 3-year and 5-year OS rates for the cohort were 68.8% and 52.3%, respectively. Univariate analysis showed no significant differences in gender, age, T/N staging, comorbidities, or second primary malignancies (all *P* > 0.05), but treatment modality was a significant predictor of both OS (P = 0.002) and DFS (P = 0.001). Multivariate COX regression analysis confirmed N staging and treatment modality as independent prognostic factors for OS (P = 0.007 and 0.002, respectively) and DFS (P = 0.009 and 0.002, respectively).
Conclusion: Elderly hypopharyngeal cancer patients tolerated surgery and postoperative radiotherapy well. Active pursuit of comprehensive treatment is recommended for fit stage III–IV patients aged ≥ 70 years to improve outcomes.

Keywords: hypopharyngeal neoplasms, squamous cell carcinoma, aged, radiotherapy, prognosis