Long Term Outcome of Routine Image-enhanced Endoscopy in Newly Diagnosed Head and Neck Cancer: a Prospective Study of 145 Patients

Abstract

Synchronous second primary tumors (SPTs), especially esophageal squamous cell neoplasia (ESCN), in patients with head and neck squamous cell carcinoma (HNSCC) are not uncommon. Image-enhanced endoscopy (IEE) screening may identify SPTs while there is no evidence to support its benefit. We prospectively recruited an adult cohort with newly-diagnosed HNSCC for IEE screening of upper gastrointestinal (UGI) tract neoplasia. 145 HNSCC patients were recruited. 22 (15.2%) patients had synchronous UGI tract neoplasia, including 20 ESCNs and 2 gastric adenocarcinoma. At a median follow-up of 2.72 (±1.73) years, the 3-year overall survival (OS) rate was 0.71. HNSCC patients with synchronous ESCN/UGI tract neoplasia had poorer prognosis than those without (multivariate analysis, hazard ratio [HR] 2.75/2.79, 95% confidence interval [CI] 1.11~6.82/1.15~6.80, p = 0.03/0.02). HNSCC patients with advanced (stage III&IV) ESCN had worst survivals (p < 0.001). Among those with synchronous ESCNs, hypopharyngeal cancers were associated with poorer prognosis when compared with oral cancers (HR 2.36, 95% CI 1.08~5.15, p = 0.03). IEE screening for UGI SPTs in HNSCC patients could be used for risk stratification and prognosis prediction. HNSCC patients with advanced ESCN had the worst prognosis. Further studies are needed to demonstrate the survival benefits from IEE screening.

Figure 1

(A,B) A right-sided hypopharyngeal cancer. (C) An uneven hyperemic mucosa surface under white-light endoscopy. (D,E) Brownish discoloration of mucosa with abnormal microvasculatures under narrow-band imaging with magnifying endoscopy. (F) A well-demarcated Lugol-unstained area. Pathology from endoscopic submucosal dissection reporting squamous cell carcinoma invading the lamina propria.

Figure 2

(A) Survival of head and neck squamous cell carcinoma (HNSCC) patients with synchronous upper gastrointestinal (UGI) tract neoplasia versus those without lesions. (B) Survival estimates according to staging of primary tumors and existence of synchronous esophageal neoplasia. (C) Survival estimates of advanced (stage III&IV) HNSCC patients with early esophageal neoplasia (stage 0~II) and those without lesions.