Risk factors for second primary neoplasia of esophagus in newly diagnosed head and neck cancer patients: a case-control study.
BACKGROUND
The prevalence of esophageal neoplasia in head and neck (H&N) cancer patients is not low; however, routine esophageal surveillance is not included in staging of newly-diagnosed H&N cancers. We aimed to investigate the risk factors for synchronous esophageal neoplasia and the impact of endoscopy on management of H&N cancer patients.


METHODS
A total of 129 newly diagnosed H&N cancer patients who underwent endoscopy with white-light imaging, narrow-band imaging (NBI) with magnifying endoscopy (ME), and chromoendoscopy with 1.5% Lugol's solution, before definite treatment were enrolled prospectively.


RESULTS
60 esophageal lesions were biopsied from 53 (41.1%) patients, including 11 low-grade, 14 high-grade intraepithelial neoplasia and 12 invasive carcinoma in 30 (23.3%) patients. Alcohol consumption [odds ratio (OR) 5.90, 95% confidence interval (CI) 1.23-26.44], advanced stage (stage III and IV) of index H&N cancers (OR 2.98, 95% CI 1.11-7.99), and lower body mass index (BMI) (every 1-kg/m2 increment with OR 0.87, 95% CI 0.76-0.99) were independent risk factors for synchronous esophageal neoplasia. NBI with ME was the ideal screening tool (sensitivity, specificity, and accuracy of 97.3%, 94.1%, and 96.3%, respectively, for detection of dysplastic and cancerous esophageal lesions). The treatment strategy was modified after endoscopy in 20 (15.5%) patients. The number needed to screen was 6.45 (95% CI 4.60-10.90).


CONCLUSIONS
NBI-ME surveillance of esophagus should be done in newly-diagnosed H&N cancer patients, especially those with alcohol drinking, lower BMI, and advanced stage of primary tumor.
Chen-Shuan
CS
Chung
Li-Jen
LJ
Liao
Wu-Chia
WC
Lo
Yueh-Hung
YH
Chou
Yi-Chen
YC
Chang
Yu-Chin
YC
Lin
Wei-Fan
WF
Hsu
Pei-Wei
PW
Shueng
Tzong-Hsi
TH
Lee
D000328:Adult; D000428:Alcohol Drinking; D001114:Areca; D015992:Body Mass Index; D002277:Carcinoma; D002278:Carcinoma in Situ; D016022:Case-Control Studies; D004938:Esophageal Neoplasms; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062048:Narrow Band Imaging; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary; D012307:Risk Factors; D012907:Smoking