Clinical Investigation Into The Prevalence And Association Factor Of Second Primary Tumor Of The Esophagus In Oral Tumor Patients

Background: Patients with head and neck squamous cell carcinoma(HNSCC) often have a second primary tumor(SPT) in their upper aerodigestive tract, most commonly in the head and neck, lung, and esophagus. The Development of second primary tumor(SPT) is a major factor in poor prognosis, despite adequate management of the primary oral cancer(OC). One to 20% patients with oral squamous cell carcinoma(OSCC) develop synchronous or metachronous esophageal cancers as SPT. This study aimed to evaluated the prevalence and the association of factors for SPT of the esophagus in oral tumor patients.Materials and Findings: The number of participants was included 80 Japanese patients with OC(53 men, 27 women; mean age(range): 66.2(23-89) years old). In 80 patients, histopathological diagnoses were oral squamous cell carcinoma(OSCC, 74 patients),oral intraepithelial neoplasia/carcinoma in situ(OIN/CIS, 4 patients) and verrucous carcinoma(VC, 2 patients). All study participants underwent esophagogastroduodenoscopy examinations(EGD). Diseases manifested in the esophagus were categorized into 3 subgroups; malignant tumor including esophageal carcinoma(EC) and intraepithelial neoplasia(IN), epithelial dysplasia(ED) and other diseases. The participants’ age, sex, Brinkman Index(BI), Sake Index(SI), decayed, missing, filled of teeth(DMF) index were evaluated whether there were associations with EGD findings or not. Participants’ social habits relating to smoking and alcohol consumption were collected from medical records. Malignant tumors such as esophageal carcinoma(EC) and intraepithelial neoplasia(IN) were diagnosed in 13 of 80 patients(16.3%), and epithelial dysplasia(ED) was detected in 7 patients(8.8%), in total 25.0% adding up by these 2 conditions. Brinkman index(as continuous variable) was selected as candidate marker for association factors. The univariate analysis for malignant tumor in the esophagus resulted in BI(as continuous and category variable with <1000 vs. >1000) was selected as candidate marker for association factors. In the multivariate analysis, BI as a continuous variable was also significant as an association factor(OR(95%CI), p-value: 2.98(1.17-7.57), p=0.022).Conclusions: We strongly suggest that endoscopic screening should be performed to identify malignancies of the esophagus in patients with OSCC, OIN/CIS and VC.