Predictors of survival in posterior cricoid squamous cell carcinoma: A study of 248 cases

Objectives: We aimed to describe the presentation, treatment patterns, and survival characteristics of posterior cricoid squamous cell carcinoma (SCC) with the National Cancer Database (NCDB). Study Design: Retrospective database review. Methods: We reviewed the NCDB from 2004 to 2013. Primary, previously untreated cases of posterior cricoid SCC were studied. Cox regression analysis was performed to look for prognostic factors. Results: Out of 14,416 hypopharyngeal malignancies, 269 (1.8%) posterior cricoid tumors were identified, of which 248 (92.2%) were SCC. Mean age at diagnosis was 65 years (range 20–90+). Most patients were Caucasian (74.7%) and male (77.1%). By presentation, 58% were classified as clinical stage tumor (cT) 3 or cT4 to cT4 disease and 57.4% were clinical node (cN) +. Radiation (RT) alone was the most common form of treatment (32.1%), followed by chemoradiation (CRT) (31.7%) and surgery plus RT (7.4%). Overall 5- and 10-year survival was 25% and 19%, respectively. Significant prognostic factors include overall clinical stage III to IV (hazard ratio [HR] 1.8 [95% confidence interval (CI) 1.15–2.82], P = 0.011), clinical nodal disease (HR 1.54 [95% CI 1.10–2.15], P = 0.012), and Charlson/Deyo comorbidity score > 1 (HR 1.94 [95% CI 1.14–3.29], P = 0.014) on univariate analysis. Conclusion: Posterior cricoid SCCs are rare hypopharyngeal malignancies with a poor prognosis. They typically present at late stage with nodal metastasis and are most commonly treated nonsurgically with primary RT or CRT. Increasing clinical stage, comorbidity, and nodal disease are associated with worse survival. Level of Evidence: 4. Laryngoscope, 127:1093–1096, 2017.