Surgery and relevant pathological evaluation
hypopharyngeal carcinomas, oropharyngeal carcinomas, carcinoma, deaths, primary lesions
ORAL CARCINOMA, LYMPH NODES, POSITIVE, POSTOPERATIVE COMPLICATIONS, DISEASE, CARCINOMA, POSTOPERATIVE COMPLICATION, DELAYED WOUND HEALING, PERIOPERATIVE COMPLICATION, CPS
The patients underwent surgery about 4 weeks after their final neoadjuvant treatment, with a mean interval of 34.9 d. 8 of the 15 patients with hypopharyngeal carcinomas underwent a pyriform sinus resection or posterior pharyngeal wall resection, 5 underwent a partial laryngectomy and hypopharyngectomy, and 2 underwent a total laryngectomy and hypopharyngectomy. The overall rate of laryngeal preservation was 90.9% (20/22). Among the 7 patients with oropharyngeal carcinomas and oral carcinomas, partial tongue or tongue root resection was performed in 3, partial laryngectomy and tongue root resection in 2 and tonsillectomy in 2 patients. In 12 patients, the primary lesion was closed directly; in 8, it was reconstructed with adjacent flaps; and in 2, it was reconstructed with free flaps. Unilateral cervical lymph node dissection was performed in 10 patients, and bilateral cervical lymph node dissection in 12 patients. Radical unilateral cervical lymph node dissection was only performed in 1 patient, with the rest receiving modified radical dissections. Delayed wound healing was the main postoperative complication, with an incidence of 22.7% (5/22). There were no severe perioperative complications or perioperative deaths. All postoperative complications were cured by conservative treatment.Eight patients achieved pCR (36.4%). In the remaining 14 patients without pCR, residuals were found in both the primary lesions and the cervical lymph nodes in 5 patients; 1 patient had a pCR only in the primary lesion, and 8 had pCR only in the lymph nodes. The overall cervical lymph node pCR rate was 71.4% (15/21) (cN0 (clinical lymph node negative), n = 1), and the overall pCR rate for primary lesions was 40.6% (9/22). Among the 13 patients with residual primary lesions, 1 presented with only local carcinoma Pathological response of the enrolled patients. pCR, Pathological complete response; MPR, Major pathological response; IPR, Incomplete pathological response; p16 expression 0 for negative, 3 for strong positive.To identify variables associated with pCR, we performed correlation analyses between pCR and patients’ demographic and clinical characteristics, condition and disease stage before neoadjuvant therapy. CPS and P16 status were used as markers for statistical analyses. There were 15 (68.2%) patients with CPS >5 in the biopsies of their primary lesions, and this was found to be correlated with pCR (Correlation Analysis for Pathological Complete Response.PR, Partial response; SD, Stable disease; CPS, Combined Positive Score; LN, Lymph nodes.