Alcohol abstinence and risk assessment for second esophageal cancer in Japanese men after mucosectomy for early esophageal cancer

Abstract

BackgroundAlcohol consumption combined with inactive aldehyde dehydrogenase-2 (ALDH2) and the presence of multiple esophageal Lugol-voiding lesions (LVLs; dysplasia) are strong predictors for multiple development of esophageal squamous cell carcinoma (ESCC) in East Asians. We invented a health risk appraisal (HRA) model for predicting the risk of ESCC based on drinking, smoking, dietary habits, and alcohol flushing, i.e., past or present facial flushing after drinking a glass of beer, a surrogate marker for inactive ALDH2.MethodsProspective follow-up examinations (median follow-up time, 50.3 months) were performed in 278 Japanese men after endoscopic mucosectomy for early ESCC (UMIN Clinical Trials Registry ID: UMIN000001676).ResultsSixty-four subjects developed metachronous ESCC. A receiver operating characteristic curve showed that HRA scores ≥12 best predicted the development of metachronous ESCC. The ESCC detection rate per 100 person-years was 9.8 in the high-HRA-score group (n = 104) and 4.5 in the low-HRA-score group (n = 174), and the risk of development of metachronous ESCC was higher in the high-HRA-score group than in the low-HRA-score group (adjusted hazard ratio: 2.00 [95% CI: 1.12–3.30]). Multiple LVLs was a very strong predictor of the development of metachronous SCC, but high HRA scores predicted it independently. The cumulative incidences of metachronous ESCC decreased after drinking cessation in the high-HRA-score drinker group (adjusted hazard ratio: 0.37 [0.14–0.97]).ConclusionsBoth the HRA model that included alcohol flushing and the multiple LVL grade predicted the development of metachronous ESCC in Japanese men after endoscopic mucosectomy for ESCC. Drinking cessation in the high-HRA-score drinker group reduced the rate of metachronous ESCC.

Endoscopic screening for synchronous esophageal neoplasia among patients with incident head and neck cancer: Prevalence, risk factors, and outcomes

“…Alcohol flushing response is associated with an inherited deficiency in the enzyme aldehyde dehydrogenase 2 (ALDH2), leading to accumulation of acetylaldehyde. 28 Only a few studies have investigated the influence of TNM stage of HNSCC on synchronous ESCN, and their results were inconsistent. 26 A review article also concluded heavy drinkers with alcohol flushing response as a high-risk subpopulation likely to develop multiple upper aerodigestive tract cancers for whom they recommended endoscopic surveillance for ESCN.…”

“…In Japan, a risk appraisal model incorporating factors including alcohol flush response can predict the risk of developing metachronous esophageal SCC among patients received mucosectomy of the early esophageal SCC. 28 Only a few studies have investigated the influence of TNM stage of HNSCC on synchronous ESCN, and their results were inconsistent. [11][12][13]16 We found only distant metastasis from HNSCC to be an independent risk factor for synchronous high-grade dysplasia/SCC in multivariate analysis.…”

Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer

“…Yokoyama et al . conducted a post hoc analysis of 278 men from the above‐mentioned prospective cohort study.…”

Long-Term Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Cell Carcinoma

“…The metachronous cancer rates are considerably high and surveillance endoscopy should be performed carefully. Abstinence from alcohol is also important to prevent recurrence [ 42 , 43 ].…”