Endoscopic screening for synchronous esophageal neoplasia among patients with incident head and neck cancer: Prevalence, risk factors, and outcomes

The Kaohsiung J of Med Scie

et al. 2019

Self Cite

This study examines the effects of environmental hazards, including tobacco, alcohol/alcohol flush response, areca nut, and Helicobacter pylori (H pylori) infection on upper digestive diseases. This is a multi‐hospital‐based endoscopy‐survey cross‐sectional study. Subjects were received upper endoscopies in outpatient clinics at four hospitals in Taiwan between 2008 and 2013. Biopsy‐based methods or urea breath test were used confirm the status of H pylori infection. In total, 8135 subjects were analyzed. Higher cumulative amounts of alcohol consumption were at higher risk of Barrett's esophagus and esophageal squamous cell carcinoma (ESCC), higher cumulative amounts of tobacco consumption were at higher risk of peptic ulcer, and higher cumulative amounts of areca nut consumption were at higher risk of duodenitis. Alcohol flush response was significant risk for reflux esophagitis and Barrett's esophagus (adjusted odds ratio [aOR] = 1.18 and 1.32, 95% confidence interval [CI] = 1.07‐1.31 and 1.06‐1.65, respectively). H pylori infection was inversely associated with ESCC risk (aOR = 0.20, 95% CI = 0.10‐0.40). In addition, H pylori infection was consistently and significantly risk factors for gastrointestinal diseases, including peptic ulcer, gastric adenocarcinoma, and duodenitis (aOR = 5.51, 1.84, and 2.10, 95% CI = 4.85‐6.26, 1.03‐3.26, and 1.71‐2.56, respectively). Besides the cumulative risk of alcohol, tobacco, and areca nut for Barrett's esophagus, ESCC, and peptic ulcer, respectively, presence of facial flushing was the significant risk for reflux esophagitis and Barrett's esophagus. H pylori infection was positively associated with peptic ulcer, gastric adenocarcinoma, and duodenitis, but inversely associated with ESCC.

Section: Discussioncontrasting

confidence: 98%

Risks of substance uses, alcohol flush response, Helicobacter pylori infection and upper digestive tract diseases—An endoscopy cross‐sectional study

Chuang

The Kaohsiung J of Med Scie

et al. 2019

Self Cite

“…The American Society of Clinical Oncology recommends symptom oriented esophageal screening in HNC survivors 18 . Nevertheless, the incidence of www.nature.com/scientificreports www.nature.com/scientificreports/ synchronous esophageal cancer might differ between eastern and western countries 5,13,19,20 . Compared with Western countries, studies from Eastern Asia have demonstrated a higher incidence of synchronous EC.…”

Section: Discussionmentioning

confidence: 99%

“…Alcohol drinking, tobacco smoking and betel nut chewing, as well as the ALDH-2 polymorphism might explain these geographic differences 21,22 . Furthermore, increased awareness of the risk of synchronous EC in patients with HNC may change a physicians' and local hospital's treatment guidelines, by using routine endoscopic screening instead of symptom oriented evaluation 10,11,14,20 . Alcohol drinking and tumor location over the oropharynx and hypopharynx, were previously identified by the authors as risk factors for developing synchronous EC.…”

Section: Discussionmentioning

confidence: 99%

A nationwide population-based study to access the risk of metachronous esophageal cancers in head and neck cancer survivors

Tseng

Lee

et al. 2020

Sci Rep

How long esophageal screening should be performed for, and on which subgroups of head and neck cancer (HNC) survivors, remains uncertain. This retrospective study analyzed data from the Taiwan National Health Insurance Research Database from 1999 to 2013. A total of 68,131 newly-diagnosed HNC patients were enrolled. Subjects who received esophageal endoscopic screening within 6 months after their diagnosis date of index HNC were identified. The incidence trends of secondary primary EC were analyzed using a Cochran-Armitage trend test. Among the 9,707 patients who received index esophageal endoscopy screening, 101 (1.0%) cases of synchronous EC were diagnosed. The 5-and 10-year cumulative incidence rates of metachronous ECs were 1.4% and 2.7%, respectively in those with an initial negative index endoscopic finding. Patients with oropharynx or hypopharynx cancers were at significantly higher risk of developing metachronous ECs compared with those with oral or larynx cancers (10-year incidence rate: 3.3% vs. 0.9%, respectively; hazard ratio: 2.15; 95% confidence intervals: 1.57-2.96). Metachronous EC continues to develop in patients with HNC even at 10-years after treatment for primary HNC. HNC patients, especially those with oropharynx or hypopharynx cancer, may require long-term endoscopic surveillance.

“…Esophageal squamous-cell carcinoma (ESCC) is one of the most common second primary cancers occurring in patients with head and neck squamous-cell carcinoma (HNSCC) [1]. Development of second ESCC significantly compromises HNSCC patients’ survival [2,3]. Habitual alcohol, betel nut, and cigarette use are established risk factors for ESCC [4], but the influence of these carcinogens on the development of second ESCC in HNSCC patients is less clear.…”

Section: Introductionmentioning

confidence: 99%

Influence of Tea Consumption on the Development of Second Esophageal Neoplasm in Patients with Head and Neck Cancer

Chen

Lai

et al. 2019

Cancers

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Alcohol is an important risk factor for the development of second esophageal squamous-cell carcinoma (ESCC) in head and neck squamous-cell carcinoma (HNSCC) patients. However, the influence of tea consumption is uncertain. We prospectively performed endoscopic screening in incident HNSCC patients to identify synchronous esophageal neoplasm. In total, 987 patients enrolled between October 2008 and December 2017 and were analyzed. In vitro studies were conducted to investigate the effect of epigallocatechin gallate (EGCG) on the betel alkaloid, arecoline-stimulated carcinogenesis in two ESCC cell lines. There were 151 patients (15.3%) diagnosed to have synchronous esophageal neoplasm, including 88 low-grade dysplasia, 30 high-grade dysplasia and 33 squamous-cell carcinoma (SCC). Tea consumption was associated with a significantly lower risk of having esophageal high-grade dysplasia or SCC in HNSCC patients, especially those who were betel nut chewers, alcohol drinkers or cigarette smokers (all adjusted odds ratio were 0.5; p-values: 0.045, 0.045 and 0.049 respectively). In vitro studies indicated that EGCG suppressed arecoline-induced ESCC cell proliferation and colony formation through the inhibition of the Akt and ERK1/2 pathway in a reactive oxygen species-independent manner. In conclusion, tea consumption may protect against the development of second esophageal neoplasms among HNSCC patients, especially those who regularly consume betel nuts, alcohol and cigarettes.