OA03-RF01.04. Biomarkers and Questionnaires for Predicting the Development of Multiple Caners Within the Esophagus or Head and Neck After Endoscopic Resection

Abstract

Esophageal Cancer: Non-Surgical Treatment of Esophageal Cancer Squamous cell carcinoma (SCC) frequently develops in multiple locations within the esophagus or head and neck and is strongly associated with alcohol consumption and smoking. Multiple primary cancers after curative treatment affect the quality of life and survival. However, long-term studies to guide risk-based endoscopic surveillance are lacking. This study included 330 patients with endoscopically treated esophageal SCC. Lifestyle factors were assessed at baseline using self-administered questionnaires. Detailed information was collected on alcohol consumption, alcohol flushing, smoking history, and intake of green-yellow vegetables and fruits. Participants completed lifestyle questionnaires (Health Risk Appraisal model: HRA and Alcohol Use Disorders Identification Test: AUDIT scores), and their mean corpuscular volume (MCV) and gamma-glutamyl transpeptidase (GGT) levels were measured. A comprehensive evaluation of squamous dysplasia across the entire esophageal mucosa is clinically challenging. Therefore, Lugol chromoendoscopy was used to evaluate the Lugol-voiding lesion (LVL), which reflects dysplastic changes even in endoscopically normal-appearing mucosa. LVL were graded according to the number of lesions per endoscopic view: grade A (0 lesions), grade B (1–9 lesions), and grade C (≥ 10 lesions). All participants underwent structured endoscopic surveillance of the esophagus or head and neck and otolaryngological examination of the head and neck. At a median follow-up of 120 months (range, 1.3–176.9), the 10-year cumulative incidence of multiple SCC within the esophagus or head and neck was 39.4%. Alcohol consumption was associated with an increased risk (HR: 1.15 for an increment of 1 unit [22 g ethanol] of alcohol consumption, 95% CI: 1.07–1.23). The 10-year cumulative incidence of multiple SCC within the esophagus or head and neck increased progressively with LVL grade: 10.4% in grade A, 29.6% in grade B, and 68.3% in grade C. Additionally, higher HRA/AUDIT scores and MCV/GGT levels were correlated with an increased number of SCC within the esophagus or head and neck. In the person-years analysis, higher HRA/AUDIT scores and MCV/GGT levels were associated with increased incidence of multiple SCC, with the LVL grade emerging as the most powerful factor for risk stratification. Long-term follow-up revealed a significant correlation between LVL grade, HRA-F/AUDIT scores, MCV/GGT levels, and the development of multiple SCC within the esophagus or head and neck. In the future, it is necessary to establish a risk-based endoscopic surveillance protocol and identify populations that should be targeted for active intervention based on these risk factors.