title: Alcohol Consumption and Multiple Dysplastic Lesions Increase Risk of Squamous Cell Carcinoma in the Esophagus, Head, and Neck.
abstract: Some patients develop multiple squamous cell carcinomas (SCCs) in the upper aerodigestive tract, attributed to field cancerization; alcohol consumption has been associated with this process. We examined the association between multiple areas of dysplastic squamous epithelium with the development of SCC of the esophagus or head and neck cancer, as well as alcohol consumption and smoking.
  
  
  
  We examined 331 patients with early stage esophageal SCC using Lugol chromoendoscopy to evaluate the dysplastic squamous epithelium in the esophagus. Patients then were assigned to 3 groups, based on the number of Lugol-voiding lesions: A, no lesion; B, 1-9 lesions; or C, 10 or more lesions. Participants completed lifestyle surveys on their history of drinking, smoking, and diet. All participants were evaluated by laryngopharyngoscopy before registration; only those without head and neck cancer were included, except for patients with superficial SCC limited to the subepithelial layer. Lesions detected in the esophagus and head and neck by surveillance were considered to be metachronous. The study end point was the cumulative incidence of metachronous SCCs in the esophagus and head and neck after endoscopic resection of esophageal SCC, according to the grade of Lugol-voiding lesions. At study entry, all patients were instructed to abstain from alcohol and smoking.
  
  
  
  Over the 2-year study period, metachronous SCCs of the esophagus were detected in 4% of patients in group A, in 9.4% of patients in group B, and in 24.7% of patients in group C (P < .0001 for patients in group A vs B or B vs C). Head and neck SCCs were detected in none of the patients in group A, in 1.7% of the patients in group B, and in 8.6% of the patients in group C (P = .016 for patients in group A vs C and P = .008 for patients in group B vs C). SCC of the esophagus or head and neck developed in 4.0% of patients in group A, in 10.0% of patients in group B, and in 31.4% of patients in group C (P < .0001 for group A vs B or A vs C). Alcohol abstinence decreased the risk of multiple SCCs of the esophagus (adjusted hazard ratio, 0.47, 95% confidence interval, 0.25-0.91; P = .025), whereas smoking abstinence did not.
  
  
  
  Multiple dysplastic lesions in the esophagus increase the risk of multiple SCCs. Alcohol abstinence reduces the risk of metachronous SCCs. Clinical Trials registry: UMIN000001676 and UMIN000005466.
authors: Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.
authors: Chikatoshi
authors: C
authors: Katada
authors: Department of Health Promotion, National Institute of Public Health, Wako, Japan.
authors: Tetsuji
authors: T
authors: Yokoyama
authors: Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan.
authors: Tomonori
authors: T
authors: Yano
authors: Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan.
authors: Kazuhiro
authors: K
authors: Kaneko
authors: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors: Ichiro
authors: I
authors: Oda
authors: Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Yuichi
authors: Y
authors: Shimizu
authors: Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
authors: Hisashi
authors: H
authors: Doyama
authors: Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors: Tomoyuki
authors: T
authors: Koike
authors: Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Kohei
authors: K
authors: Takizawa
authors: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
authors: Motohiro
authors: M
authors: Hirao
authors: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors: Hiroyuki
authors: H
authors: Okada
authors: Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan.
authors: Takako
authors: T
authors: Yoshii
authors: Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
authors: Kazuo
authors: K
authors: Konishi
authors: Department of Gastroenterology, Kumamoto Regional Medical Center, Kumamoto, Japan.
authors: Takenori
authors: T
authors: Yamanouchi
authors: Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan.
authors: Takashi
authors: T
authors: Tsuda
authors: Department of Endoscopy Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan.
authors: Tai
authors: T
authors: Omori
authors: Department of Diagnostic Imaging, Tochigi Cancer Center, Utsunomiya, Japan.
authors: Nozomu
authors: N
authors: Kobayashi
authors: Division of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Tadakazu
authors: T
authors: Shimoda
authors: Division of Pathology, National Cancer Center Hospital and Hospital East, Tokyo, Japan.
authors: Atsushi
authors: A
authors: Ochiai
authors: Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Yusuke
authors: Y
authors: Amanuma
authors: Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Shinya
authors: S
authors: Ohashi
authors: Research Center for Environmental Quality Management, Kyoto University, Otsu, Japan.
authors: Tomonari
authors: T
authors: Matsuda
authors: Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Hideki
authors: H
authors: Ishikawa
authors: Clinical Research Unit, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan.
authors: Akira
authors: A
authors: Yokoyama
authors: Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: mmuto@kuhp.kyoto-u.ac.jp.
authors: Manabu
authors: M
authors: Muto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064829:Alcohol Abstinence; D000428:Alcohol Drinking / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D000077277:Esophageal Squamous Cell Carcinoma; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D061848:Optical Imaging; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016540:Smoking Cessation
keywords: Carcinogenesis; Drinking Alcohol; Genetics Methods; Risk Factor