Division of Gastroenterology and Hepatology, (g)Division of Medical Oncology and Hematology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Oral Oncol. 2019 Sep;96:27-33. doi: 10.1016/j.oraloncology.2019.06.038. Epub 2019 Jul 4.
Esophageal second primary tumors (SPTs) in head and neck cancer (HNC) patients is not uncommon. The impact of image-enhanced endoscopy (IEE) screening for esophageal SPT on the outcome of HNC patients has not been well clarified.
Patients with malignancies of the head and neck region and esophagus were recruited from a hospital-based cancer registry between July 2000-December 2016. IEE screening included magnifying endoscopy with narrow-band imaging and chromoendoscopy with Lugol's solution. Biopsied specimens with revised Vienna classification categories 1 and 2 were defined as group I, and those with categories 3 to 5 were defined as group II. The Kaplan-Meier estimate and Cox regression model were used for survival analysis.
Totally 1577 HNC and 501 esophageal cancer patients were enrolled. The 5-year overall survival (OS) rates of stage I/II HNC, stage III/IV HNC and esophageal cancer patients were 58%, 29%, and 8%, respectively (p < 0.01). The 5-year OS rate of HNC patients with negative IEE results was higher than that of HNC patients without IEE screening, followed by IEE screening groups I, II and esophageal cancer patients (44% vs. 39% vs. 35% vs. 11% vs. 8%, respectively, p for trend <0.01). Among advanced HNC patients, those who received IEE screening had a trend of better prognosis than those without screening (5-year OS rate of 31% vs. 28%, p = 0.17).
IEE screening for esophageal SPTs is helpful in risk stratification and prognosis prediction for HNC patients. Routine IEE screening is recommended in HNC patients.
头颈部癌症（HNC）患者中食管第二原发肿瘤（SPT）并不少见。增强内镜（IEE）筛查食管 SPT 对 HNC 患者结局的影响尚未得到充分阐明。
本研究从 2000 年 7 月至 2016 年 12 月间的医院癌症登记处招募头颈部区域和食管恶性肿瘤患者。IEE 筛查包括窄带成像放大内镜和卢戈氏液染色内镜。根据修订后的维也纳分类标准，活检标本为 1 类和 2 类的被定义为 I 组，为 3 至 5 类的被定义为 II 组。采用 Kaplan-Meier 估计和 Cox 回归模型进行生存分析。
共纳入 1577 例 HNC 和 501 例食管癌患者。I 期/II 期、III 期/IV 期和食管癌患者的 5 年总生存率（OS）分别为 58%、29%和 8%（p<0.01）。IEE 检查结果阴性的 HNC 患者的 5 年 OS 率高于未行 IEE 筛查的 HNC 患者，其次是 IEE 筛查 I 组、II 组、食管癌患者（44%比 39%比 35%比 11%比 8%，趋势检验 p<0.01）。在晚期 HNC 患者中，行 IEE 筛查者的预后好于未行筛查者（5 年 OS 率 31%比 28%，p=0.17）。
IEE 筛查食管 SPT 有助于 HNC 患者的风险分层和预后预测。建议对 HNC 患者进行常规 IEE 筛查。
