title: Lugol-voiding lesions are an important risk factor for a second primary squamous cell carcinoma in patients with esosphageal cancer or head and neck cancer.
abstract: OBJECTIVE
  Lugol-voiding lesions (LVLs), detected by chromoendoscopy using iodine dye in patients with esophageal squamous cell carcinoma (EC) or head and neck squamous cell carcinoma (HNC), are associated with a second primary carcinoma in the other organ. We undertook a cross-sectional and retrospective cohort study to assess the risk for second primary carcinomas according to the severity of LVLs, on the basis of their number and size.
  
  
  METHODS
  A total of 1,060 patients with only EC, only HNC, or both EC and HNC (EC+HNC) underwent esophageal endoscopic examination between January 1994 and January 2010. The patients were classified according to the number of LVLs in an endoscopic visual field and the size of the largest LVLs. Factors associated with the second primary EC or HNC were analyzed.
  
  
  RESULTS
  Univariate analysis showed that a larger number and size of LVLs increased the risk for synchronous and early metachronous second primary cancer (P value for trend <0.0001). Multivariate analysis showed that a number of LVLs ≥20 (EC+HNC vs. only HNC, odds ratio (OR)=15.7; EC+HNC vs. only EC, 3.5) and a size ≥10 mm (EC+HNC vs. only HNC, OR=3.1; EC+HNC vs. only EC, 3.2) were independent risk factors for synchronous and early metachronous second primary cancer. A larger number of LVLs was a risk factor for metachronous EC and HNC, and a size ≥10 mm was a risk factor for late metachronous EC.
  
  
  CONCLUSIONS
  The severity of LVLs in patients with HNC or EC closely correlated with a second primary carcinoma in the other organ. Patients with LVLs must be followed closely for development of a second primary carcinoma.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hori
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kawahara
authors.forename: Ryuta
authors.initials: R
authors.lastname: Takenaka
authors.forename: Sachiko
authors.initials: S
authors.lastname: Shimizu
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ohno
authors.forename: Tomoo
authors.initials: T
authors.lastname: Onoda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Sirakawa
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Naomoto
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D004396:Coloring Agents; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007454:Iodides; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000473:pathology*; D012307:Risk Factors
chemical_list: D004396:Coloring Agents; D007454:Iodides; C010389:Lugol's solution