Field Cancerization Of Hypopharyngeal Carcinoma And Its Clinical Significance

Background:Head and neck squamous cell carcinoma is the sixth most common malignant tumors.Although the incidence of hypopharyngeal cancer was not high,but it was the worst prognosis in the head and neck cancer.The important factors,which might affect the prognosis of hypopharyngeal cancer,are local recurrence and and with second primary cancer.Hypopharyngeal cancer are the most vulnerable to have a second primary cancer of the esophagus,which is closely related to field cancerization.Therefore,having a deep understanding about hypopharyngeal carcinoma with synchronous second primary carcinoma of the esophagus,and getting early detection of esophagus lesions is vital to improve the prognosis of hypopharyngeal carcinoma.Objective:To investigate the risk factors,endoscopic evaluation methods and survival status of hypopharyngeal carcinoma with synchronous second primary carcinoma of the esophagus.Methods:One hundred and sixty patients with newly diagnosed hypopharyngeal carcinoma from January 2009 to December 2012 were retrospectively reviewed.The clinical materials,tumor-related information and follow-up results were collected and analyzed.Results:Forty-three synchronous esophageal carcinomas(27%)were detected in 160 hypopharyngeal carcinoma patients.A total of 131 patients received Lugol iodine staining under esophageal endoscopy and 29 patients did not.Forty cases of esophageal cancer were found in the Lugol iodine staining group,with a detection rate of 31%(40/131).Among them there were thirty-one early esophageal carcinomas(stage 0+1),about 78%(31/40),Only three cases of esophageal cancer were found under routine esophageal endoscopic examination without Lugol iodine staining,with a detection rate of 10%(3/29)and with no early esophageal carcinoma.There was a statistically significant difference between these groups(X2=4.925,P=0.026).There was a total of 264 anatomical sites of invasion in the 160 cases observed under the white light imaging(WLI)mode and 388 sites under the narrow band imaging(NBI)mode.There was a significant difference between these two groups(t=8.532,P<0.001).On univariate analysis,the median age of less than 55 years old(X2=4.525,P=0.033),excessive alcohol consumption(X2=6.942,P=0.008)and invasion site more than 3 anatomical regions(X2=21.503,P=0.000)had a significant correlation with the occurrence of synchronous esophageal carcinomas.Multivariate analysis showed that excessive alcohol consumption(OR=4.787,P=0.029)and invasion site more than 3 anatomical regions(OR=14.391,P=0.000)were independent risk factors.The median survival time was 26 months in 43 hypopharyngeal carcinoma patients with synchronous esophageal carcinomas,which was significantly lower than that in patients with hypopharyngeal carcinoma without secondary primary esophageal carcinomas(median survival time was 58 months,X2=11.981,P=0.001).Furthermore,the median survival time was 36 months for the patients with early esophageal cancer(stages 0 and I),which was significantly longer than for those with advanced esophageal cancer(stages II and III)(15 months,X2=9.509,P=0.002).Conclusions:Hypopharyngeal carcinoma is difficult in the early diagnosis and has poor prognosis.There was a high incidence of synchronous esophageal carcinoma in hypopharyngeal carcinoma patients,which might be an important factor affecting the prognosis of hypopharyngeal carcinoma.Surveillance for esophageal carcinomas in patients with hypopharyngeal carcinoma,especially in excessive alcohol drinkers,is warranted.The extent of invasion of hypopharyngeal carcinoma was better to be evaluated by NBI endoscopy,esophageal lesions recommended Lugol iodine staining endoscope,which will help to predict the second primary esophageal carcinoma and early detection of esophageal carcinoma.