The Presence of Second Primary Esophageal Tumor (Spet) is Still an Independent Negative Prognostic Factor for Head and Neck Cancer (Hnc) Patients: a Retrospective Study

Aim: Head and neck cancer (HNC) patients have a high incidence of primary esophageal tumor. Moreover, second primary esophageal tumor (SPET) also had a negative impact on survival of HNC patients and previous studies reported that 3-year survival rate of HNC patients with SPET was 0-15%. Therefore, the establishment of optimal management for HNC patients with SPET is crucial. Recent advances in endoscopy such as magnifying endoscopy enabling early detection of esophageal tumor and the novel treatment may lead to improve survival for HNC patients with SPET. Methods: A total of 226 HNC patients who underwent magnifying esophagogastroduodenoscopy at our institute from October 2005 to September 2012 were retrospectively examined in this study. We investigated the incidence of SPET, the difference in the therapeutic outcome between HNC patients with and without SPET and the prognostic value of the presence of SPET in HNC patients. Results: Out of 226 HNC patients, 34 patients (15%) had SPET during their clinical course. The median age was 71 years (range 51 to 88) and 33 patients were male. All patients had squamous cell esophageal carcinoma. The majority of patients (79%) had SPET with stage 0 (26%) or 1(53%) disease. Out of 34 patients with SPET, 10 patients (29%) underwent endoscopic resection for SPET and 10 patients (29%) underwent simultaneous chemoradiation therapy with cisplatin plus continuous infusional 5-fluorouracil for HNC and SPET. The median over survival was 23.9 months in HNC patients with SPET, as compared with 27.0 months in HNC patients without SPET. The 3-years survival rates in HNC patients with SPET and in HNC patients without SPET were 50.9% and 72.0 %, respectively. Multivariate analysis identified the clinical stage of HNC (p = 0.01, hazard ratio 2.36) and the presence of SPET (p = 0.03, hazard ratio 1.9) as significant and independent determinants of overall survival. Conclusions: Our study suggested that although survival of HNC patients with SPET might be considerably improved due to early detection and treatment of SPET, the presence of SPET still remained an independent negative prognostic factor for HNC patients. Disclosure: All authors have declared no conflicts of interest.