Elsevier

Oral Oncology

Volume 55, April 2016, Pages 55-60
Oral Oncology

Regular screening of esophageal cancer for 248 newly diagnosed hypopharyngeal squamous cell carcinoma by unsedated transnasal esophagogastroduodenoscopy

https://doi.org/10.1016/j.oraloncology.2016.01.008Get rights and content

Highlights

  • Simultaneous ESCC is common (15%) in newly diagnosed HSCC patients.

  • Alcohol and N3 disease of HSCC are the risk factors for esophageal lesions.

  • The overall survival of HSCC patients with ESCC was worse than those without ESCC.

Summary

Objectives

Esophageal squamous cell carcinoma (ESCC) is common in hypopharyngeal squamous cell carcinoma (HSCC) patients. This prospective study is to reveal the prevalence of simultaneous ESCC in newly diagnosed HSCC patients by unsedated transnasal esophagogastroduodenoscopy (EGD) and to analyze the clinical predictors for simultaneous esophageal lesions and their survival.

Materials and methods

248 patients with newly diagnosed HSCC and without previous head and neck cancer between 2007 and 2014 were prospectively evaluated for HSCC and simultaneous esophageal lesions by unsedated transnasal EGD. The clinical factors for simultaneous esophageal lesions were evaluated. Survival analysis of the HSCC patients receiving complete treatment was done.

Results

The mean age was 58 years. 170 HSCC (68.5%) were classified as T3–T4. The procedures were successfully performed (98.4%), except 4 huge tumors. 174 HSCC (85.7%, out of 203 tumors biopsied) were pathologically proved malignancy by this technique. Regarding esophageal lesions (45.5%), ESCC occurred in 36 patients (14.8%), dysplasia without ESCC occurred in 23 (9.4%) and Lugol voiding lesion without ESCC or dysplasia occurred in 52 (21.3%). Alcohol drinking (adjusted OR: 6.95, p < 0.05) and N3 classification (adjusted OR: 2.41, p < 0.05) of HSCC were the independent risk factors for the presence of esophageal lesions. The overall survival of the HSCC patients with ESCC was significantly lower than those without ESCC (p = 0.013).

Conclusions

Unsedated transnasal EGD is a promising technique for diagnosis of HSCC and simultaneous ESCC. Simultaneous esophageal lesions including ESCC (15%) are common in newly diagnosed HSCC patients, especially with alcohol drinking or N3 disease.

Introduction

Hypopharyngeal squamous cell carcinoma (HSCC) is one of the most common head and neck cancers, with the poorest prognosis among primary head and neck cancers. Delayed diagnosis, frequent regional neck lymph node metastasis and distant failure are the main causes of its poor prognosis. Besides, second primary esophageal squamous cell carcinoma (ESCC) are common in patients with HSCC, with the incidence of 10–50% [1], [2], [3], [4], [5], [6], which may be because HSCC and ESCC have the same environmental causative factors including alcohol, cigarette and betel nut [7], [8]. Second primary ESCC significantly leads to poor prognosis despite adequate control of primary HSCC [1], [4], [9]. Therefore, regular screening of the esophagus in HSCC patients at diagnosis is reasonable and has been recommended to detect simultaneous ESCC [1], [10].

For screening purpose, flexible esophagoscopy or esophagogastroduodenoscopy (EGD) is the most effective tool to exclude simultaneous ESCC, especially for small superficial tumors, which are not easily detected by other imaging studies including barium esophagogram, CT, MRI, and PET [1], [5]. However, it is sometimes difficult to use conventional EGD per oral route in patients with locally advanced HSCC or patients with trismus, especially where betel nut chewers are common [11]. Previously, we successfully used small-calibered EGD transnasally to diagnose HSCC and to check the esophagus without conscious sedation at the same time and found 6 simultaneous ESCCs (22%) in 27 newly diagnosed HSCCs [12]. Based on that preliminary experience, unsedated transnasal EGD becomes a regular diagnostic tool for patients with newly diagnosed HSCC, trying to pathologically prove hypopharyngeal cancer and to screen simultaneous ESCC in our hospital. In this paper, we report this prospective experience of unsedated transnasal EGD for diagnosis of 248 newly diagnosed HSCCs and the prevalence of simultaneous esophageal lesions including ESCC, esophageal dysplasia and Lugol voiding lesions (LVLs), and try to find the clinical predictors for simultaneous esophageal lesions and their survival.

Section snippets

Eligible subjects

All patients with suspicious or newly diagnosed HSCC were enrolled in this prospective study to receive transnasal EGD before cancer treatment. Conventional rigid laryngoscopy under general anesthesia was only done within 2 weeks after EGD examination when transnasal EGD did not obtain the adequate tissue for pathological diagnosis of HSCC. The exclusion criteria were prior esophageal resection, hypopharyngeal cancer but not squamous cell carcinoma in nature, recurrent HSCC, other head and neck

Results

Between May 2007 and December 2014, a total of 248 patients with newly diagnosed HSCC, including 241 men and 7 women were enrolled in this study (Table 1). The age ranged from 32 to 89 years, with a mean of 58 years. Two hundred and nineteen tumors (88.3%) were identified in the pyriform sinus, 20 tumors (8%) arose from the posterior hypopharyngeal wall and 5 tumors (2%) were located in postcricoid area. Fifty four HSCCs (21.8%) were classified as T1–T2 and 170 HSCCs (68.5%) were classified as

Discussion

Anatomically, the hypopharynx and esophagus are the continuous structures with the similar mucosal epithelium and both are for food swallow, so that the hypopharynx and esophagus expose to very similar exogenous or endogenous substances and carcinogens. Many epidemiologically case-control or longitudinal follow-up studies have shown that HSCC and ESCC share the same environmental risk factors including alcohol and cigarette in most countries and betel nut besides in Southeast Asia, which cause

Conclusions

About 45% of the 248 patients with newly diagnosed HSCC have simultaneous esophageal lesions, especially heavy alcoholic drinkers and the patients with large neck metastases, which include ESCC in 15% of the patients, esophageal dysplasia without ESCC in another 9% and LVLs without ESCC or esophageal dysplasia in the other 21%, Unsedated transnasal EGD can be the first endoscopic technique for pathological diagnosis of HSCC and screening of simultaneous ESCC during a single session.

Conflict of interest statement

None declared.

Acknowledgement

“This work was supported in part by the National Science Council of the Republic of China (NSC 98-2314-B-002-046-MY3, 101-2314-B-002-061-MY3, and 102-2628-B-002-033-MY3).”

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