Results
Table 1 summarizes the characteristicsof the cohort of patients. There
were 702 consecutive patients with newly diagnosed and untreated HNSCCs
with oesophagoscopy and bronchoscopy done at primary diagnosis in the
inclusion period. There were 522 male and 180 female patients. The mean
age of the patients was 63 years old (range,25-94 years old). There were
393 patients (56%)who were active or ex-smokers, 209 patients
(29.8%)who were drinkers or ex-drinkers and 182 patients (25.9%)who
were smokers and drinkers.
Majority of sites of primary malignancies were in the oral cavity (356
patients, 50.7%), followed by laryngeal (126 patients, 17.9%),
hypopharyngeal (110 patients, 15.7%), oropharyngeal (74 patients,
10.5%) and paranasalsinuses and nasal cavity cancers (33 patients,
4.7%). For staging, most of the patients were having stage 4 disease on
presentation (357 patients, 50.9%), whereas there were 162 (23.2%), 92
(13.1%) and 89 (12.7%) patients with stage 1,2 and 3 disease
respectively.
The rate of synchronousmalignancies was8.3% (58/702 patients).Figure 1
and 2 shows the Kaplan-Meier survival curve showing overall survival and
disease-free survival of the cohort. When comparing between patients
with synchronousmalignancies and patients with no
synchronousmalignancies (single primary malignancy), the one-year and
three-year overall survival (OS) rate were significantly lower in the
former group than the latter (one-year OS 40.8% vs 83.25%, P
<0.0005; three-year OS 6.8% vs 54.0%, P<0.0005).
The same would apply for disease free survival (DFS) rate (one-year DFS
24.5% vs 68.8%, P<0.0005; three-year DFS 6.8% vs 50.1%,
P<0.0005).
Characteristics of synchronousmalignancies were delineated in table 2.
Among all primary subsites, hypopharynx carried the highest rate of
synchronousmalignancies at 27.3% (30/110 patients). There was a
relatively low incidence of synchronousmalignancies in other primary
subsites. In terms of sites of synchronousmalignancies, most of them
occurred in oesophagus (41/58 patients, 73.2%), followed by sites other
than the aerodigestive tract(9/58 patients, 15.5%), lung (5/58
patients, 8.9%), head and neck (3/58 patients, 5.4%).
There were three synchronousmalignancies in the head and neck
region.Amongst them, two were detectable on clinical examination (one at
tongue from a primary hypopharyngeal cancer and another at lower
alveolus from a primary cancer at maxillary sinus). The remaining one
was at tongue base from a primary retromolar trigone cancer. It was
non-suspicious at initial endoscopy but showed increase uptake when
working up with PET-CT and therefore biopsy was performed to confirm the
malignancy.
The rate of synchronousoesophagealmalignancies was 5.8% (41/702
patients).The majority of the synchronousoesophagealmalignancies were
suffering from primary hypopharyngeal cancers (25/41 patients, 61.0%),
following by oral cavity cancers (8/41 patients, 19.5%), laryngeal
cancers (4/41 patients, 9.8%) and oropharyngeal cancers (4/41 patients,
9.8%). Most of the synchronousoesophagealmalignancies detected were
early diseases, with 53.7% of them having stage 1 disease. Risk factors
for synchronousoesophagealmalignancies included male gender (Odds ratio
OR 14.89, 95% CI: 2.03-109.08), smoker status (OR 3.33, 95% CI: 1.51
– 7.30), drinker status (OR 26.14, 95% CI: 9.18 – 74.40) and primary
hypopharyngeal cancer (OR 10.59, 95% CI: 5.43 – 20.64). Out of the 41
patients with synchronousoesophagealmalignancies, 14 of them (34%)
wereonly detectable with oesophagoscopy and not by other means of
investigation including CT scans of the thorax and PET-CT scans.
Therefore, the exclusive detection rate for oesophagoscopy among all
subjects was 2.0% (14/702 patients). 4 of these 14 patients were
asymptomatic., 13 of themwere having stage 1 diseaseand only 1 of them
was having a stage 3 disease. The overall survival and disease-free
survivalof patients with oesophagealmalignancies exclusively detectable
with oesophagoscopy were significantly better when comparing with other
synchronousoesophagealmalignancies not exclusively detected by
oesophagoscopy (P = 0.028).
The rate of synchronous lung malignancies was 0.7% (6/702 patients).
Among these 6 patients, 4 of themwere detected on chest x-ray, one by
PET-CT and one by bronchoscopy. However, all of themwere detectable by
PET-CT when being further worked up. Therefore, the exclusive detection
rate by bronchoscopy is 0%.
No complications oesophageal or bronchial perforation occurred amongst
all patients in the study period. The medianfollow-up period for the
cohort of patients was 23 months (Range: 0-120 months).