title: Glasgow prognostic score and neutrophil-lymphocyte ratio are good prognostic indicators after radical neck dissection for advanced squamous cell carcinoma in the hypopharynx.
abstract: OBJECTIVE
  Locally advanced carcinomas arising in the hypopharynx have been traditionally treated by resection of the hypopharynx, larynx, and cervical esophagus. However, the prognosis of these patients is still low. In the present study, we retrospectively analyzed the long-term survival of patients with locally advanced hypopharyngeal squamous cell carcinoma (HSCC) reconstructed by jejunal graft.
  
  
  METHODS
  Between 2004 and 2014, 68 patients with HSCC were treated at Tottori University Hospital. Nine patients with synchronous esophageal cancer were excluded. We analyzed the overall survival of 59 patients with clinical stage III and IV HSCC who underwent pharyngo-laryngo-cervical esophagectomy with definitive tracheostomy followed by free jejunal graft reconstruction. Additionally, prognostic significances of preoperative patients' Glasgow prognostic score (GPS), neutrophil-lymphocyte ratio (NLR), and prognostic nutritional index were analyzed.
  
  
  RESULTS
  Postoperative complications occurred in 18.6 % of 59 patients. There were no cases of graft loss, and no patient died from complications. Preoperative poor performance status of patients was a risk factor for postoperative complications. The 5-year overall survival rate of the 59 patients was 46.1 %, and the median survival time was 28 months. In univariate and multivariate survival analyses, high GPS (1 or 2), and high NLR (≥5) were recognized as independent poor prognostic markers for patients with HSCCs.
  
  
  CONCLUSIONS
  Pharyngo-laryngo-cervical esophagectomy followed by free jejunal reconstruction was performed safely. Additional treatment, such as chemoradiotherapy, should be introduced for patients with high preoperative GPS or NLR after curative operation.
authors.affiliation: Tottori Prefectural Central Hospital, 730 Ezu, Tottori, 680-0901, Japan. ikeguchim@pref.tottori.jp.
authors.forename: Masahide
authors.initials: M
authors.lastname: Ikeguchi
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009367:Neoplasm Staging; D009504:Neutrophils; D009752:Nutritional Status; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Free jejunal graft; Hypopharyngeal squamous cell carcinoma; Overall survival; Pharyngo-laryngo-cervical esophagectomy; Prognostic parameters