Macroscopic and radiologic classification of hypopharyngeal squamous cell carcinoma

Hypopharyngeal squamous cell carcinoma (HPSCC) carries the worst prognosis among mucosal head‑and‑neck sites. Reliable pretreatment risk markers are needed to refine therapy.

Eighty‑four consecutive patients with biopsy‑proven invasive HPSCC (2016-2023) were retrospectively reviewed. Tumors were typed endoscopically and on contrast CT using the Japanese Esophageal Cancer Criteria and collapsed into localized (Types 1‑2) versus infiltrative (Types 3‑4) patterns. Clinicopathologic variables were analyzed with χ² or Fisher exact tests; overall survival (OS) and disease specific survival (DSS) was estimated by Kaplan-Meier and compared by log‑rank; independent predictors were identified with Cox regression.

Localized morphology was present in 49 of 84 tumors (58.3%) and correlated with female sex, non‑smoking, and lower T category (all P < .05). Nodal metastasis rates (∼65%) were similar in both groups. In T3/T4 disease, 3‑year OS was 54.9% for localized versus 45.0% for infiltrative tumors (P = .039). On multivariable analysis, infiltrative morphology (hazard ratio [HR] 2.11; 95% CI 1.12‑3.95) and alcohol use (HR 1.83; 95% CI 1.14‑2.95) independently predicted worse OS.

A simple macroscopic classification provides stage‑independent prognostic information in HPSCC and can guide airway management and treatment intensity. Prospective multicenter validation-integrating radiomics and molecular profiling-is warranted.