Evaluating Clinical Outcomes and Predictive Factors of Treatment Approaches in T1–3N3b Hypopharyngeal Carcinoma: Upfront Neck Dissection Versus Concurrent Chemoradiotherapy

Background This study assessed the efficacy of upfront neck dissection (ND) versus concurrent chemoradiotherapy (CRT) in patients diagnosed with T1–3N3b hypopharyngeal carcinoma (HPC). Methods This retrospective study enrolled patients with T1–3N3b HPC who had undergone upfront ND followed by CRT (upfront group) or CRT (CRT group). Local control rate, neck control rate (NCR), metastasis‐free rate, disease‐free survival (DFS), disease‐specific survival, and overall survival (OS) were compared between the upfront and CRT groups. Univariate and multivariate analyses using Cox proportional hazards models were performed to identify the survival‐related clinical factors. Lymph node status and salvage surgery were also analyzed. Results Forty‐eight patients were enrolled in this study, with 18 in the upfront group and 30 in the CRT group. The groups differed significantly in terms of NCR ( p = 0.000121) and DFS ( p = 0.0256). The lymph node status was found to be a significant prognostic factor for OS in univariate and multivariate analyses. When comparing the upfront, CRT‐R (resectable lymph nodes), and CRT‐UR (unresectable lymph nodes) groups, significant differences were observed in NCR ( p = 0.0005), DFS ( p = 0.0123), DSS ( p = 0.0312), and OS ( p = 0.0159). The upfront group had better outcomes compared to both CRT‐R and CRT‐UR. In the analysis considering salvage surgery, a significant difference was found in the NCR between the upfront and CRT ± salvage ND groups ( p = 0.003). Conclusion Upfront ND followed by CRT may improve NCR and DFS in patients with stage T1–3N3b HPC compared to CRT. Upfront ND should be considered as a treatment option, provided resectability is feasible.