Effect of esophageal cancer screening on mortality among patients with oral cancer and second primary esophageal cancer in Taiwan

Yi-Hsun Chen; Chi-Mei Ho; Meng-Shieh Wu; Wen-Hung Hsu; Winnie Yen-Yun Wang; Shyng-Shiou F Yuan; Hui-Min Hsieh; I-Chen Wu

doi:10.1016/j.amjoto.2023.103856

Effect of esophageal cancer screening on mortality among patients with oral cancer and second primary esophageal cancer in Taiwan

Am J Otolaryngol. 2023 Jul-Aug;44(4):103856. doi: 10.1016/j.amjoto.2023.103856. Epub 2023 Mar 23.

Authors

Yi-Hsun Chen¹, Chi-Mei Ho², Meng-Shieh Wu³, Wen-Hung Hsu⁴, Winnie Yen-Yun Wang⁵, Shyng-Shiou F Yuan⁶, Hui-Min Hsieh⁷, I-Chen Wu⁸

Affiliations

¹ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City 80756, Taiwan.
² Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, No. 68, Jhonghua 3rd Rd, Cianjin District, Kaohsiung City 80145, Taiwan.
⁴ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City 80756, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City 80756, Taiwan.
⁵ School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 807377, Taiwan; Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan; Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807377, Taiwan.
⁶ Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan; Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807377, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807377, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu 300093, Taiwan; Center For Intelligent Drug Systems and Smart Bio-devices, National Chiao Tung University, Hsinchu 300093, Taiwan.
⁷ Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan; Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: hsiehhm@kmu.edu.tw.
⁸ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City 80756, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine and Center for Cancer Research, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City 80756, Taiwan. Electronic address: minica@kmu.edu.tw.

PMID: 37062150
DOI: 10.1016/j.amjoto.2023.103856

Abstract

Objective: Oral and esophageal cancer are the fourth and fifth leading causes of cancer deaths among men in Taiwan. Despite a good prognosis for oral cavity cancer patients, survival is worse for those who develop second primary esophageal cancer. There remains no consensus regarding early prevention of potential second primary esophageal cancer in patients with oral cavity cancer. Our study aimed to compare 5-year mortality between endoscopically screened and non-screened patients with oral cavity cancer and second primary esophageal cancer.

Materials and methods: This study identified patients with incident oral cavity cancer and second primary esophageal cancer during 2004 and 2013 using the Taiwan Cancer Registry and National Health Insurance Research Database. We compared 5-year mortality from the second primary esophageal cancer diagnosis date between screened and non-screened groups of patients with oral cavity cancer and second primary esophageal cancer.

Results: A total of 217 screened and 305 non-screened oral cavity cancer patients with second primary esophageal cancer were studied. Endoscopic screening significantly improved early detection of second primary esophageal cancer (adjusted odds ratio: 0.34, 95 % confidence interval [CI]: 0.23-0.49) and reduced all-cause mortality (adjusted hazard ratio: 0.80; 95 % CI: 0.66-0.98).

Conclusions: Oral cavity cancer patients with second primary esophageal cancer may have worse overall survival than those without. Early detection of second primary esophageal cancer is a crucial mediator between endoscopic screening and mortality. Endoscopic screening after the diagnosis of incident oral cavity cancer significantly increased early detection and reduced all-cause mortality.

Keywords: Comparative effectiveness; Endoscopic screening; Esophageal cancer; Oral cavity caner.

MeSH terms

Early Detection of Cancer
Esophageal Neoplasms* / diagnosis
Humans
Male
Mouth Neoplasms* / diagnosis
Neoplasms, Second Primary* / diagnosis
Taiwan / epidemiology