Yonsei Med J.  2015 May;56(3):812-818. 10.3349/ymj.2015.56.3.812.

Predictors of Thyroid Gland Involvement in Hypopharyngeal Squamous Cell Carcinoma

• Chang JW
• Koh YW
• Chung WY
• Hong SW
• Choi EC

• KMID: 2450358
• DOI: http://doi.org/10.3349/ymj.2015.56.3.812

Abstract

PURPOSE
Decision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer.
MATERIALS AND METHODS
A retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer.
RESULTS
The incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024).
CONCLUSION
Ipsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer.

Keyword

Hypopharyngeal cancer; total laryngopharyngectomy; thyroidectomy; thyroid cartilage invasion

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Squamous Cell/epidemiology/pathology/*surgery
Disease-Free Survival
Female
Humans
Hypopharyngeal Neoplasms/epidemiology/pathology/*surgery
Incidence
*Laryngectomy
Male
Middle Aged
Neoplasm Invasiveness
Neoplasms, Second Primary/epidemiology/pathology/surgery
*Pharyngectomy
Predictive Value of Tests
Prevalence
Republic of Korea/epidemiology
Retrospective Studies
Thyroid Gland/*pathology/surgery
Thyroid Neoplasms/epidemiology/*secondary
Thyroidectomy/*methods

Figure

• 

  Fig. 1 Direct thyroid gland invasion of hypopharyngeal cancer. (A) Thyroid cartilage (ThyC) destruction is noted on contrast-enhanced neck CT (thick arrow). Thyroid gland invasion by tumor extension (thin arrows) through the area of thyroid cartilage destruction is noted on the axial and coronal views of neck CT. (B) Histological section showing direct thyroid gland invasion through the thyroid cartilage (left, H&E ×12; right, H&E ×30): squamous cell carcinoma (thick arrows), thyroid gland (thin arrows). The scale bar denotes 1 mm.

• 

  Fig. 2 Multifocal thyroid gland invasion by ipsilateral metastasis of hypopharyngeal cancer without direct extension through the thyroid cartilage. (A) An approximately 3.5-mm primary mass lesion extending from the post-cricoid region to the pyriform sinus is noted without definite thyroid cartilage involvement (upper left). Multiple foci of metastatic thyroid gland invasion (thin arrows) are noted without direct connections to the primary lesion (thick arrow) on the coronal view of contrast-enhanced neck CT (upper right). Thyroid invasion of hypopharyngeal cancer at the mid-pole (lower left) and upper pole (lower right) of the thyroid gland are revealed without destruction of the surrounding soft tissue, including the cartilage. (B and C) Histological section showing no direct thyroid gland invasion. (B) Squamous cell carcinoma fully invaded the hypopharynx (thick arrow), but the fibroadipose tissue and thyroid cartilage are well preserved without cancer invasion (H&E, ×12). (C) There is no associated lesion between the metastasis of the upper pole of the thyroid (thin arrow) and primary tumor (H&E, ×12). The scale bar denotes 1 mm. (D) Histological section showing tumor emboli in the lymphatic channel (H&E, ×40). The scale bar denotes 0.25 mm. Thick arrow: tumor emboli. ThyC, thyroid cartilage; V, vessel; L, lymphatic channel.

• 

  Fig. 3 Prognosis according to thyroid gland invasion. The prognosis of patients with hypopharyngeal cancer with thyroid gland invasion was worse than that of patients with noninvasive tumors. DSS, disease-specific survival; DFS, disease-free survival.

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