Clinical significance of intensive endoscopic screening for synchronous esophageal neoplasm in patients with head and neck squamous cell carcinoma.
OBJECTIVE
Patients with head and neck squamous cell carcinoma (HNSCC) often develop second primary tumors in the upper aerodigestive tract. Early detection of synchronous esophageal squamous cell neoplasm (ESCN) is important because the prognosis of HNSCC can be affected by the statuses of second primary tumors.


METHODS
In a prospective study, 308 patients with HNSCC were screened for synchronous ESCN between May 2010 and April 2012. All patients underwent conventional white-light endoscopic examination with Lugol chromoendoscopy and narrow band image.


RESULTS
The median age was 61 years (range, 26-87 years), and the male-to-female ratio was 4.2:1. Two hundred and thirty-four patients (76.0%) were current or ex-smokers, 207 patients (67.2%) had a history of alcohol consumption and 56 patients (18.2%) had previous history of cancer. Synchronous ESCN was detected in 22 patients (7.1%), and most patients were at an early stage. The locations of index HNSCC in these patients were as follows: hypopharynx (n = 12), larynx (n = 6), oropharynx (n = 2) and oral cavity (n = 2). Synchronous ESCN was detected in 25.5% (12/47) of hypopharyngeal cancer and in 27.8% (15/54) of HNSCC involving the pyriform sinus. Multivariate analysis showed that smoking (current smoker vs. never smoker, Odds Ratio [OR] 8.3, p = 0.028), a history of cancer (OR 5.0, p = 0.002) and pyriform sinus involvement (OR 9.2, p < 0.0001) increased the risk of developing synchronous ESCN.


CONCLUSIONS
Patients with HNSCC, especially those who are current smokers, have a history of cancer and have pyriform sinus involvement, should undergo intensive endoscopic screening to detect synchronous ESCN.
Departments of Gastroenterology, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, Asan Medical Center , Seoul , Korea.
Do Hoon
DH
Kim
Eun Jeong
EJ
Gong
Hwoon-Yong
HY
Jung
Hyun
H
Lim
Ji Yong
JY
Ahn
Kwi-Sook
KS
Choi
Jeong Hoon
JH
Lee
Kee Don
KD
Choi
Ho June
HJ
Song
Gin Hyug
GH
Lee
Jin Ho
JH
Kim
Jong-Lyel
JL
Roh
Seung-Ho
SH
Choi
Soon Yuhl
SY
Nam
Sang Yoon
SY
Kim
Seunghee
S
Baek
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000209:etiology; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000209:etiology; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062048:Narrow Band Imaging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D000077195:Squamous Cell Carcinoma of Head and Neck
esophageal neoplasm; head and neck neoplasm; second primary neoplasm; squamous cell neoplasm