Method
A retrospective review of electronic medical records was conducted on consecutive patients with newly diagnosed and untreated HNSCCsin a tertiary referral center. In our center, newly diagnosed HNSCC patients were screened with oesophagoscopy and bronchoscopy at the time of diagnosisand therefore all patients were included in the study.The endoscopic procedure was done in outpatient setting under local anesthesia and using trans-nasal flexible endoscopy. With the trans-nasal flexible endoscopy, the nasopharyngeal, oropharyngeal, laryngeal, and pharyngeal areas will be inspected, following by oesophagoscopy (for oesophagus down to oesophageal gastric junction) and bronchoscopy (for tracheobronchial tract).
Synchronousmalignancies were defined as malignancies that were detected during the initial workup upon the diagnosis of the primary malignancy at other sites in the upper aerodigestive tract.Exclusion criteria included HNSCC arising fromnon-aerodigestive tract region in head and neck region (ear, skin, salivary glands, lacrimal glands), tumorswith non-squamous cell carcinomas histology, patient with history of nasopharyngeal carcinomas, patients with previous history of irradiation and patients of non-East Asian ethnicity. Information regarding patient’s demographics, subsites and staging of primary and synchronousmalignancies, pickup rate by other means of investigations like PET-CT (Positron emission tomography- computed tomography scan), survival statistics (disease free survival and overall survival) will be recorded and studied. Staging of primary and synchronousmalignancies was done in accordance to the eighth edition of the AJCC Cancer Staging Manual (TNM classification from the American Joint Committee on Cancer [AJCC]).
All data was input into Excel spreadsheets (Microsoft Excel for Mac 2013 version 15; Microsoft Corporation, Redmond, Washington). Data analysis was done with SPSS version 24.0 software (IBM, Armonk, New York). Differences in means for normally distributed variables was assessed with 2-tailed unpaired t test. Differences in means for non-normally distributed variables was assessed with Mann-Whitney U test. P value was set at <0.05 to be statistically significant.