Predictive Value of the Glasgow Prognostic Score for Prognosis in Patients with Hypopharyngeal Squamous Cell Carcinoma Treated with Curative Radiotherapy

<b>Background/Objectives:</b> Hypopharyngeal squamous cell carcinoma (HPSCC) carries a poor prognosis, and reliable, inexpensive biomarkers are needed to refine risk-stratified treatment. The Glasgow Prognostic Score (GPS), integrating C-reactive protein and albumin, reflects systemic inflammation and nutritional status, but its prognostic utility in curative radiotherapy for HPSCC remains unclear. <b>Methods:</b> We retrospectively reviewed 98 consecutive patients with pathologically confirmed HPSCC who received definitive tomotherapy (70 Gy in 35 fractions) from June 2015 to February 2024 at a single tertiary center. Pretreatment GPS was classified as 0-2. Overall survival (OS) and progression-free survival (PFS) were assessed by Cox proportional hazards models, which evaluated associations between GPS and other clinical parameters. <b>Results:</b> Median age was 68 years (range 41-89); 92% were male. GPS distribution was 0 in 74 patients (76%), 1 in 18 (18%), and 2 in 6 (6%). After a median follow-up of 36.2 months, 3-year OS and PFS for the whole cohort were 78.7% and 51.7%, respectively. Patients with GPS 0 showed significantly higher 3-year OS than those with GPS 1-2 (83.6% vs. 62.2%; <i>p</i> = 0.023). On multivariate analysis, elevated GPS (1-2) remained an independent predictor of worse OS (hazard ratio [HR] 2.62, 95% CI 1.03-6.70; <i>p</i> = 0.044) alongside poor performance status and advanced stage. <b>Conclusions:</b> Pretreatment GPS independently stratifies overall survival in HPSCC patients undergoing curative radiotherapy, complementing established clinical factors. Because CRP and albumin are routinely available, GPS may assist in identifying high-risk patients who could benefit from intensified multidisciplinary treatment. Prospective multicenter studies are warranted to validate these findings.