Old age decreases the risk of lymph node metastasis in T1-2 hypopharynx squamous cell carcinoma patients

Cervical lymph node metastasis (LNM) is an important prognostic factor for hypopharynx squamous cell carcinoma (SCC) patients, which can be detected in a large fraction of clinically diagnosed early hypopharynx SCC patients; however, the importance of knowing the risk of LNM in the younger/older patients has not been well defined. The objective of this study is to assess the effect of age and LNM in T1-2 hypopharynx SCC patients. Patients with T1-2 hypopharynx SCC were extracted from the Surveillance, Epidemiology and End Results database between 2005 and 2014. Univariate and multivariate logistic regression models were produced to recognize the association between age and risk factors of LNM. A total of 1018 patients were analyzed. Older patients have a lower risk of LNM compared with their younger peers ( P < 0.01). In multivariate analyses, older age was associated with a significantly lower risk of LNM. Compared with patients aged 80-93 years old, the hazard ratios for patients aged 31-49, 50-59, 60-69, and 70-79 years old were 2.464 [95% confidence interval (CI): 1.338-4.537], 2.668 (95% CI: 1.638-4.346), 3.192 (95% CI: 1.957-5.205), and 1.564 (95% CI: 0.945-2.588), respectively. Subgroup analysis shows that the effect of older age was significantly associated with a higher risk of LNM in Caucasian male who harbored moderately/poorly differentiated tumors. Our study demonstrates that older patients with T1-2 hypopharynx SCC had a lower risk of LNM than their younger peers, especially males with moderately/poorly differentiated tumors. More accurate assessments of LNM and prophylactic neck dissection or prophylactic adjuvant radiation therapy to the neck will be imperative for reducing recurrence in younger T1-2 hypopharynx SCC.