title: The benefit of pretreatment esophageal screening with image-enhanced endoscopy on the survival of patients with hypopharyngeal cancer.
abstract: BACKGROUND
  Synchronous esophageal cancers can suppress the survival of patients with hypopharyngeal cancers. Esophageal screening with the image-enhanced endoscopy may identify more synchronous cancers while there is no evidence to support its benefit on survival.
  
  
  METHODS
  A total of 281 and 320 patients were diagnosed with hypopharyngeal cancer before and after the policy of routine esophageal screening. Primary outcome measures were overall survival.
  
  
  RESULTS
  Among those who received screening, 49 patients (49/180, 27.2%) had synchronous esophageal cancers; treatment planning was changed in 42 (23.3%). Before and after the policy, percentages of stage I-II synchronous cancers were 20% (3/15) and 53.1% (26/49), respectively. Adjunctive therapies for synchronous cancers have led to a better survival after the policy than before (P = 0.002). The Cox regression model quantified a survival benefit of 29% (95% CI: 11-43%) when adjusting for TNM stage of hypopharyngeal cancer. In post-policy period, the survival was better for those who chose screening than those who did not (HR: 0.57, 95% CI: 0.41-0.79). Among those without screening, there was no difference between the pre- and post-policy periods (HR: 0.96, 95% CI: 0.74-1.26).
  
  
  CONCLUSIONS
  Patients with hypopharyngeal cancers may benefit from the esophageal screening with image-enhanced endoscopy through the better detection of early-stage synchronous cancers.
authors.affiliation: Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
authors.forename: Wen-Lun
authors.initials: WL
authors.lastname: Wang
authors.forename: Cheng-Ping
authors.initials: CP
authors.lastname: Wang
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
authors.forename: Ching-Tai
authors.initials: CT
authors.lastname: Lee
authors.forename: Chi-Yang
authors.initials: CY
authors.lastname: Chang
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Tai
authors.forename: Cheng-Hao
authors.initials: CH
authors.lastname: Tseng
authors.forename: Tzer-Zen
authors.initials: TZ
authors.lastname: Hwang
authors.forename: Chih-Chun
authors.initials: CC
authors.lastname: Wang
authors.forename: Jo-Lin
authors.initials: JL
authors.lastname: Lo
authors.forename: Ping-Huei
authors.initials: PH
authors.lastname: Tseng
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Chiu
authors.forename: Jang-Ming
authors.initials: JM
authors.lastname: Lee
authors.forename: Jenq-Yuh
authors.initials: JY
authors.lastname: Ko
authors.forename: Pei-Jen
authors.initials: PJ
authors.lastname: Lou
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Lee
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000175:diagnosis*; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis
keywords: Esophageal cancer; Hypopharyngeal cancer; Image-enhanced endoscopy; Survival; Synchronous neoplasms