Endoscopic Surveillance for Metachronous Esophageal Squamous Cell Neoplasms among Head and Neck Cancer Patients

Abstract

Esophageal squamous cell neoplasms (ESCNs) are the most common second primary neoplasm in patients with head and neck squamous cell carcinoma (HNSCC), and few studies have focused on metachronous ESCNs. We aimed to evaluate the incidence of and risk factors for metachronous ESCNs and to provide a reasonable endoscopic follow-up plan for HNSCC patients. We extended our prospective cohort since October 2008 by recruiting incident HNSCC patients. All enrolled patients were interviewed to collect information on substance use (smoking, alcohol, and betel nut) and esophagogastroduodenoscopy (EGD) with Lugol chromoendoscopy results for synchronous ESCNs soon after HNSCC diagnosis. Endoscopic screenings for metachronous ESCNs were performed 6 to 12 months after the previous examinations. A total of 1042 incident HNSCC patients were enrolled, but only 175 patients met all the criteria and were analyzed. A total of 20 patients had metachronous ESCNs (20/175, 11.4%). Only the initial Lugol-voiding lesion (LVL) classification significantly predicted the development of metachronous ESCNs. Patients with an LVL classification of C/D had a higher risk of developing metachronous ESCNs than those with an LVL classification of A/B (adjusted odds ratio: 5.03, 95% confidence interval: 1.52–16.67). The mean interval for developing metachronous ESCNs was 33 months, but the shortest interval for developing metachronous esophageal squamous cell carcinoma was 12 months. Lugol chromoendoscopy screening among incident HNSCC patients predicts the risk of developing metachronous ESCNs. A closer follow-up with an endoscopy every 6 months is recommended for those with LVL classifications of C and D.

Long-term results of an endoscopic screening program for superficial esophageal cancer in patients with head and neck squamous cell carcinoma

“…In our series, the overall 1-, 3-, and 5-year survival rates were 87.2 %, 68.1 %, and 58.59%, respectively. In a 10-year endoscopic surveillance cohort, HNSCC patients without dysplasia had the best survival rate compared to LGD and HGD or SCC (72.3 % vs 54.9 % vs 32.4 %, P < .0001) [19]. Notably, in the present series, the survival curves were similar between the patients without ESCC versus those with ESCC detected at an early stage, while the patients with advanced ESCC had a significantly worse prognosis, with an estimated 5-year survival probability of only 11.4 %.…”

“…Prospective studies have reported ESCC prevalence rates of 5.1 % to 12.5 % among patients with HNSCC, with differences attributed to both geographical variation and the location of the primary head and neck tumor 6 15 16 17 18 19 . These rates are higher than the estimated prevalence of 0.74 % in the general population 20 .…”

Comparative effectiveness and stage‐shift effect of endoscopic exam among newly diagnosed oral cancer patients with different stages in Taiwan

“…Clinically, synchronous SPEC is defined as another cancer diagnosed within 6 months after detection of the first primary oral cancer, as frequently defined in previous studies. [18][19][20] The date of the first endoscopic examination within that time frame was defined as the index date for the screened group. Given that nonscreened patients lacked specific endoscopic screening dates, we randomly assigned a pseudo index date based on the dynamic frequency distribution of the interval between entry date and time exposure to the endoscopic examination from the screened group.…”

“…[15][16][17] One hospital-based study in Taiwan suggested that patients were encouraged to undergo endoscopic screening in the first 3 years after HNC diagnosis. 18 A review study moderately recommended endoscopic screening every 6-12 months for 10 years. 9 However, most literature and guidelines recommend regular endoscopic screening for patients with HNC in general, especially those with hypopharyngeal and oropharyngeal cancer, because of higher SPEC reveal rates among these patients than among those with oral cancer.…”

“…9 However, most literature and guidelines recommend regular endoscopic screening for patients with HNC in general, especially those with hypopharyngeal and oropharyngeal cancer, because of higher SPEC reveal rates among these patients than among those with oral cancer. 5,10,[18][19][20] However, few studies specifically evaluated the benefit of endoscopic screening for patients with oral cancer. In addition, few studies specifically assessed the stage-shift effect of endoscopic exam on early stage SPEC diagnosis among patients with oral cancer.…”