Is a Preoperative Gastrointestinal Endoscopy for Second Primary Cancer Detection in Head and Neck Cancer Necessary? Ten-year Registry Data

Gyeong Mi Heo; Mi Hee Kim; Jin Hwan Kim; Young Soo Rho; Woon Geon Shin

doi:10.4166/kjg.2016.68.1.23

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Heo, Kim, Kim, Rho, and Shin: Is a Preoperative Gastrointestinal Endoscopy for Second Primary Cancer Detection in Head and Neck Cancer Necessary? Ten-year Registry Data

Original Article

Korean J Gastroenterol 2016;68(1):23-28.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.68.1.23

Is a Preoperative Gastrointestinal Endoscopy for Second Primary Cancer Detection in Head and Neck Cancer Necessary? Ten-year Registry Data

Gyeong Mi Heo, Mi Hee Kim, Jin Hwan Kim¹, Young Soo Rho¹, Woon Geon Shin

Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea

¹Department of Otorhinolaryngology, Hallym University College of Medicine, Seoul, Korea

Correspondence to: Woon Geon Shin, Division of Gastroenterology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, 150 Seongan- ro, Gangdong-gu, Seoul 05355, Korea. Tel: +82-2-2225-2814, Fax: +82-2-478-6925, E-mail: sgun9139@gmail.com

Received 5 April 2016 Revised 12 May 2016 Accepted 14 May 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

In head and neck squamous cell carcinoma, second primary gastrointestinal tumors are not uncommon. However, it is unclear whether a screening endoscopy is needed for detecting gastrointestinal neoplasm in patients with head and neck cancer. Therefore, we analyzed the prevalence and independent risk factors for second primary gastrointestinal neoplasm in head and neck squamous cell carcinoma.

Methods

A consecutive series of 328 patients with primary head and neck squamous cell carcinoma that underwent esophagogastroduodenoscopy or colonoscopy were included using our registry. An age- and sex-matched group of 328 control subjects was enrolled. We assessed risk factors of synchronous gastrointestinal cancer.

Results

The prevalence of esophageal cancer with head and neck squamous cell carcinoma was significantly higher than that of the control group (1.5% vs. 0.0%, p=0.011). An age of 54 years or more (OR, 1.033; 95% CI, 1.008–1.059; p=0.009) and male gender (OR, 4.974; 95% CI, 1.648–15.013; p=0.004) were risk factors for concomitant colorectal cancer or adenomas in the head and neck squamous cell carcinoma patients.

Conclusions

Preoperative colonoscopy can be recommended for detecting synchronous second primary colorectal lesions in head and neck squamous cell carcinoma patients with male sex regardless of age, and esophagogastroduodenoscopy is necessary in all head and neck squamous cell carcinoma patients for detecting esophageal cancer.

Keywords: Head and neck neoplasms, Esophagogastroduodenoscopy, Colonoscopy, Diagnosis

References

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Table 1.

Clinicopathological Data for Patients with HNSCC and the Control Group

Variable	HNSCC group (n=328)	Control group (n=328)	p-value
Sex			1.000
Male	281 (85.7)	281 (85.7)
Female	47 (14.3)	47 (14.3)
Age (yr)	60.18 (19–89)	60.23 (19–89)	0.998
Alcohol
Heavy drinking (>60 g/daily)	149 (45.4)	67 (20.4)	<0.0001
Moderate drinking	94 (28.7)	92 (28.0)
None	85 (25.9)	169 (51.5)
Smoking
Current smoking	220 (67.1)	46 (14.0)	<0.0001
Ex smoking	21 (6.4)	60 (18.3)
None	87 (26.5)	222 (67.7)
Underlying disease
Hypertension	74 (22.6)	77 (23.5)	0.858
Diabetes mellitus	27 (8.2)	37 (11.3)	0.654
Head and neck cancer location
Supraglottic cancer	36 (11.0)
Glottic cancer	71 (21.6)
Hypopharynx cancer	46 (14.0)
Nasopharynx cancer	11 (3.4)
Tonsil cancer	51 (15.5)
Tongue cancer	54 (16.5)
Palate cancer	11 (3.4)
Maxillar cancer	12 (3.7)
Others	36 (11.0)
Stage
I	87 (26.5)
II	126 (38.4)
III	59 (18.0)
IV	56 (17.1)

Values are presented as n (%) or mean (range).

HNSCC, head and neck squamous cell carcinoma.

Table 2.

Characteristics of Synchronous Gastrointestinal Neoplasm with HNSCC and the Control Group

Gastrointestinal neoplasm	HNSCC group	Control group	p-value
Esophageal cancer	5/328 (1.5)	0/328 (0.0)	0.011
Gastric cancer	4/328 (1.2)	6/328 (1.8)	1.000
Gastric adenoma	3/328 (0.9)	2/328 (0.6)	0.400
Colon cancer	7/224 (3.1)	17/328 (5.2)	0.292
Colon adenoma	83/224 (37.1)	117/328 (35.7)	0.787

Values are presented as n (%).

HNSCC, head and neck squamous cell carcinoma.

Table 3.

Univariate Analysis of Risk Factors in HNSCC Patients with or without Colon Cancer vs. with or without Colon Cancer or Adenoma

Variable	With colon cancer (n=7)	Without colon cancer (n=217)	p-value	With colon cancer or adenoma (n=90)	Without colon cancer or adenoma (n=134)	p-value
Age (yr)	71.29±5.16	59.00±11.93	<0.0001	62.01±10.03	57.62±12.85	0.003
Sex			0.37			0.001
Male	7 (100.0)	188 (86.6)		86 (95.6)	109 (81.3)
Female	0 (0.0)	29 (13.4)		4 (4.4)	25 (18.7)
Location of lesion			0.44			0.03
Supraglottic	2 (28.6)	19 (8.8)		11 (12.2)	10 (7.5)
Glottis	1 (14.3)	38 (17.5)		19 (21.1)	20 (14.9)
Hypopharynx	3 (42.9)	32 (14.7)		18 (20.0)	17 (12.7)
Nasopharynx	0 (0.0)	8 (3.7)		2 (2.2)	6 (4.5)
Tonsil	0 (0.0)	35 (16.1)		14 (15.6)	21 (15.7)
Tongue	1 (14.3)	39 (18.0)		7 (7.8)	33 (24.6)
Palate	0 (0.0)	9 (4.1)		2 (2.2)	7 (5.2)
Maxillar	0 (0.0)	12 (5.5)		4 (4.4)	8 (6.0)
Others	0 (0.0)	25 (11.5)		13 (14.4)	12 (9.0)
Alcohol			1.00			0.08
Heavy drinking (>60 g/daily)	3 (42.9)	100 (46.1)		48 (53.3)	55 (41.0)
Moderate drinking	2 (28.6)	66 (30.4)		22 (24.4)	46 (34.3)
None	2 (28.6)	51 (23.5)		20 (22.2)	33 (24.6)
Smoking			0.26			0.007
Current smoking	7 (100.0)	141 (65.0)		69 (76.7)	79 (59.0)
Ex smoking	0 (0.0)	16 (7.4)		6 (6.7)	10 (7.5)
None	0 (0.0)	60 (27.6)		15 (16.7)	45 (33.6)
Diabetes mellitus			0.53			0.33
Present	0 (0.0)	19 (8.8)		19 (21.1)	33 (24.6)
Absent	7 (100.0)	198 (91.2)		71 (78.9)	101 (75.4)
Hypertension			0.21			0.48
Present	3 (42.9)	49 (22.6)		7 (7.8)	12 (9.0)
Absent	4 (57.1)	168 (77.4)		83 (92.2)	122 (91.0)

Values are presented as mean±SD or n (%).

Table 4.

Multivariate Logistic Regression Analysis of Risk Factors for Colon Cancer and Colon Cancer or Adenoma among the HNSCC Patients

	Risk factor	Adjusted OR	95% CI	p-value
Colon cancer	Age (≥65 yr)	1.126	1.028–1.234	0.01
Colon cancer or adenoma	Age (≥54 yr)	1.033	1.008–1.059	0.009
	Sex (male)	4.974	1.648–15.013	0.004

HNSCC, head and neck squamous cell carcinoma.

Including variables for adjustment: age, sex, location of lesion, smoking.

Table 5.

Positive and Negative Predictive Value of the Risk Factors for Colon Cancer and Colon Cancer or Adenoma among the HNSCC Patients

Risk factor		n/n	PPV (%)	n/n	NPV (%)
For colon cancer	Age (≥65 yr)	7/78	9.0	146/146	100.0
For colon cancer or adenoma	Age (≥54 yr)	68/145	46.9	57/79	72.2
	Sex (male)	86/195	44.1	25/29	86.2

HNSCC, head and neck squamous cell carcinoma; PPV, positive predictive value; NPV, negative predictive value.

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