Tumor Surface Necrosis on Laryngoscopy Predicts Prognosis in Hypopharyngeal Carcinoma

ABSTRACT Objective The objective is to evaluate the prognostic significance of tumor surface necrosis (TSN) in hypopharyngeal squamous cell carcinoma (HPSCC), a feature commonly observed during laryngoscopic examination. Methods We retrospectively analyzed 346 HPSCC patients who underwent laryngoscopy at our institution between January 2004 and December 2023. Following univariable and multivariable analyses and model diagnostics, a prognostic nomogram was constructed. The model's performance was assessed using discrimination and calibration measures. Comparative evaluation against the previous model was performed using integrated discrimination improvement (IDI) and net reclassification improvement (NRI). Results The presence of TSN was significantly associated with reduced overall survival (p = 0. 0002), disease‐free survival (p < 0. 0001), local recurrence‐free survival (p = 0. 004), and regional recurrence‐free survival (p < 0. 0001). The final nomogram incorporated TSN (p < 0. 001), tumor invasion depth (p = 0. 001), lymphovascular invasion (p = 0. 023), Rclassification (p < 0. 001), and pTclassification (p < 0. 001). The area under the curve (AUC) values for 12‐, 36‐, and 60‐month survival were 0. 789, 0. 791, and 0. 759, respectively. Calibration curves demonstrated good concordance between predicted and observed outcomes. The new model showed significantly improved performance over the previous version (p < 0. 001), with NRIs of 0. 080, 0. 123, and 0. 129, and IDIs of 0. 040, 0. 049, and 0. 051 at 12, 36, and 60 months, respectively. Conclusion TSN identified via laryngoscopy was established as an independent risk factor for poor prognosis in HPSCC. The enhanced nomogram integrating TSN with key clinicopathological variables offers improved predictive accuracy, supporting better risk stratification and identification of high‐risk patients. Level of Evidence 4.