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. 2021 Oct 16;13(10):491-501.
doi: 10.4253/wjge.v13.i10.491.

Clinical impact of gastrointestinal endoscopy on the early detection of pharyngeal squamous cell carcinoma: A retrospective cohort study

Hideaki Miyamoto  1 , Hideaki Naoe  1 , Jun Morinaga  2 , Kensuke Sakisaka  1 , Sayoko Tayama  1 , Kenshi Matsuno  1 , Ryosuke Gushima  1 , Masakuni Tateyama  1 , Takashi Shono  3 , Masanori Imuta  4 , Satoru Miyamaru  5 , Daizo Murakami  5 , Yorihisa Orita  5 , Yasuhito Tanaka  6
Affiliations

Clinical impact of gastrointestinal endoscopy on the early detection of pharyngeal squamous cell carcinoma: A retrospective cohort study

Hideaki Miyamoto et al. World J Gastrointest Endosc. .

Abstract

Background: In recent years, with the growing availability of image-enhanced gastrointestinal endoscopy, gastroenterologists have contributed to the early detection of pharyngeal squamous cell carcinomas (SCC).

Aim: To clarify the clinical characteristics of pharyngeal SCCs detected by gastrointestinal endoscopy.

Methods: This is a retrospective cohort study conducted in a single-center, a university hospital in Japan. We retrospectively assessed the clinical records of 522 consecutive patients with oropharyngeal or hypopharyngeal SCC who were examined in our hospital between 2011 and 2018. The lesions were classified into two groups: Group GE (detected by gastrointestinal endoscopy) and Group non-GE (detected by means other than gastrointestinal endoscopy). The clinical characteristics were compared between the two groups. Continuous data were compared using the Mann-Whitney U test. Pearson's χ 2 test or Fisher's exact test was used to analyze the categorical data and compare proportions. The Kaplan-Meier method was used to estimate the cumulative patient survival rates.

Results: In our study group, the median age was 65 years and 474 patients (90.8%) were male. One hundred and ninety-six cases (37.5%) involved the oropharynx and 326 cases (62.5%) involved the hypopharynx. Three hundred and ninety-five cases (75.7%) had some symptoms at the time of diagnosis. One hundred and forty-five (27.8%) cases had concurrent ESCC or a history of ESCC. One hundred and sixty-four (31.4%) cases were detected by gastrointestinal endoscopy and classified as Group GE. The proportions of asymptomatic cases, cTis-1 cases and cases with no lymph node metastasis were significantly higher in Group GE than Group non-GE (61.6% vs 7.3%, P < 0.001, 32.9% vs 12.0%, P < 0.001 and 69.5% vs 19.0%, P < 0.001). Endoscopic laryngo-pharyngeal surgery or endoscopic submucosal dissection were performed in only 0.6% of the lesions in Group non-GE but in 21.3% of the lesions in Group GE (P < 0.001). Overall survival was significantly longer in Group GE than in Group non-GE (P = 0.018). The 2-year and 4-year survival rates were 82.5% and 70.7% in Group GE, and 71.5% and 59.0% in Group non-GE, respectively.

Conclusion: Gastrointestinal endoscopy plays an important role in the early detection and improving the prognosis of pharyngeal SCCs.

Keywords: Endoscopic surgery; Gastrointestinal endoscope; Gastrointestinal imaging; Head and neck imaging; Hypopharyngeal neoplasm; Oropharyngeal neoplasm.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflicts of interest associated with this manuscript.

Figures

Figure 1
Figure 1
A case of T1 hypopharyngeal cancer located in the left pyriform sinus, detected by gastrointestinal endoscopy. A: The lesion was recognized as a slightly reddish area under white light image endoscopy; B: The lesion was clearly visualized using narrow-band imaging; C, D: Under general anesthesia, en bloc endoscopic submucosal dissection was successfully completed.
Figure 2
Figure 2
The subsites of primary lesions and the proportion of Group gastrointestinal endoscopy by subsite. The proportions of Group gastrointestinal endoscopy (GE) in the oropharynx and hypopharynx were 15.4% and 42.3%, respectively. Among the lesions in the oropharynx, the proportions of Group GE in the anterior and lateral wall were lower than the posterior wall. There was no significant difference in the proportion of Group GE by subsite in the hypopharynx.
Figure 3
Figure 3
Trends in the detection modality and clinical stage of pharyngeal cancer. A: A comparison of the proportion of Group gastrointestinal endoscopy between the first and second half periods (2011–2014 and 2015–2018); B: A comparison of the proportion of cTis-1 lesions between first and second half periods (2011–2014 and 2015–2018). Group GE: Group gastrointestinal endoscopy.
Figure 4
Figure 4
Kaplan–Meier estimates of overall survival. HR: Hazard ratio; CI: Confidence interval; GE: Gastrointestinal endoscopy.
See this image and copyright information in PMC

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