Hypopharyngeal cancer is one of the most aggressive head and neck malignancies, characterized by late diagnosis and a poor prognosis. Selecting the optimal radical treatment strategy remains a challenging clinical issue, highlighting the need for a comparative analysis of existing methods to improve personalized therapy.

Aim: To conduct a retrospective real-world data analysis and evaluate treatment outcomes in patients with locally advanced stage III and IVa squamous cell hypopharyngeal carcinoma.

Materials and methods. A retrospective analysis was conducted on 120 patients with stage III-IVa squamous cell hypopharyngeal carcinoma (2013–2024). Patients were divided into four groups: Group 1 – surgery with adjuvant therapy (n = 11); Group 2 – neoadjuvant chemotherapy (NACT) followed by surgery (n = 20); Group 3 – chemotherapy and radiation therapy (n = 72); Group 4 – chemoradiotherapy (n = 17). Overall survival (Kaplan–Meier method) and recurrence characteristics were evaluated. Multivariate Cox regression analysis was applied to identify independent prognostic factors, adjusting for clinical and morphological characteristics (T stage, N stage, grade G, growth form, age and gender).

Results. The lowest 1-year mortality was recorded in Group 2 (25.0 %) and Group 1 (36.4 %), while in non-surgical groups, it reached 62.5–70.6 %. Group 2 demonstrated the highest 3-year survival rate (65.0 %), significantly exceeding the results of Group 3 (29.1 %) and Group 4 (23.5 %). Recurrence rates were highest in Group 2 (60.0 %). According to multivariate Cox regression analysis, treatment with the NACT + surgery algorithm (Group 2) was associated with improved overall survival compared to the conservative standard (HR = 0.38, p = 0.023), indicating its possible role as a favorable prognostic factor.

Conclusions. Retrospective real-world data analysis demonstrated that treatment algorithms involving a surgical component are associated with higher 3-year overall survival rates (36.4–65.0 %) compared to non-surgical methods (23.5–29.1 %). The strategy of NACT followed by surgery showed the highest survival (65.0 %). The higher recorded recurrence rate in surgical groups (60.0 %) may be related to prolonged patient survival and broader opportunities for effective salvage therapy. However, these findings are associative and require confirmation in prospective studies.