Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2021; 13(10): 491-501
Published online Oct 16, 2021. doi: 10.4253/wjge.v13.i10.491
Clinical impact of gastrointestinal endoscopy on the early detection of pharyngeal squamous cell carcinoma: A retrospective cohort study
Hideaki Miyamoto, Hideaki Naoe, Jun Morinaga, Kensuke Sakisaka, Sayoko Tayama, Kenshi Matsuno, Ryosuke Gushima, Masakuni Tateyama, Takashi Shono, Masanori Imuta, Satoru Miyamaru, Daizo Murakami, Yorihisa Orita, Yasuhito Tanaka
Hideaki Miyamoto, Hideaki Naoe, Kensuke Sakisaka, Sayoko Tayama, Kenshi Matsuno, Ryosuke Gushima, Masakuni Tateyama, Yasuhito Tanaka, Department of Gastroenterology and Hepatology, Kumamoto University Hospital, Kumamoto 860-8556, Japan
Jun Morinaga, Department of Clinical Investigation, Kumamoto University Hospital, Kumamoto 860-8556, Japan
Takashi Shono, Department of Gastroenterology, Kumamoto Chuo Hospital, Kumamoto 860-8556, Japan
Masanori Imuta, Department of Radiology, Kumamoto University Hospital, Kumamoto 860-8556, Japan
Satoru Miyamaru, Daizo Murakami, Yorihisa Orita, Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Hospital, Kumamoto 860-8556, Japan
Author contributions: Miyamoto H, Naoe H, Morinaga J, Shono T and Tanaka Y were involved in the analysis and interpretation of data and drafting the manuscript; Sakisaka K, Tayama S, Matsuno K and Gushima R participated in the study coordination and acquisition of data; Tateyama M, Imuta I, Miyamaru S, Murakami D, and Orita Y critically revised the manuscript for important intellectual content; Tanaka Y approved the final version of the article for publication; All authors approved the final version.
Institutional review board statement: This study has been ethically approved by the Kumamoto University Ethics Committee (Approval No. 1851).
Conflict-of-interest statement: The authors declare no conflicts of interest associated with this manuscript.
Data sharing statement: All data relevant to the study are included in the article. No additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yasuhito Tanaka, MD, Professor, Department of Gastroenterology and Hepatology, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan. ytanaka@kumamoto-u.ac.jp
Received: March 6, 2021
Peer-review started: March 6, 2021
First decision: July 3, 2021
Revised: July 26, 2021
Accepted: September 16, 2021
Article in press: September 16, 2021
Published online: October 16, 2021
Abstract
BACKGROUND

In recent years, with the growing availability of image-enhanced gastrointestinal endoscopy, gastroenterologists have contributed to the early detection of pharyngeal squamous cell carcinomas (SCC).

AIM

To clarify the clinical characteristics of pharyngeal SCCs detected by gastrointestinal endoscopy.

METHODS

This is a retrospective cohort study conducted in a single-center, a university hospital in Japan. We retrospectively assessed the clinical records of 522 consecutive patients with oropharyngeal or hypopharyngeal SCC who were examined in our hospital between 2011 and 2018. The lesions were classified into two groups: Group GE (detected by gastrointestinal endoscopy) and Group non-GE (detected by means other than gastrointestinal endoscopy). The clinical characteristics were compared between the two groups. Continuous data were compared using the Mann–Whitney U test. Pearson’s χ2 test or Fisher's exact test was used to analyze the categorical data and compare proportions. The Kaplan–Meier method was used to estimate the cumulative patient survival rates.

RESULTS

In our study group, the median age was 65 years and 474 patients (90.8%) were male. One hundred and ninety-six cases (37.5%) involved the oropharynx and 326 cases (62.5%) involved the hypopharynx. Three hundred and ninety-five cases (75.7%) had some symptoms at the time of diagnosis. One hundred and forty-five (27.8%) cases had concurrent ESCC or a history of ESCC. One hundred and sixty-four (31.4%) cases were detected by gastrointestinal endoscopy and classified as Group GE. The proportions of asymptomatic cases, cTis-1 cases and cases with no lymph node metastasis were significantly higher in Group GE than Group non-GE (61.6% vs 7.3%, P < 0.001, 32.9% vs 12.0%, P < 0.001 and 69.5% vs 19.0%, P < 0.001). Endoscopic laryngo-pharyngeal surgery or endoscopic submucosal dissection were performed in only 0.6% of the lesions in Group non-GE but in 21.3% of the lesions in Group GE (P < 0.001). Overall survival was significantly longer in Group GE than in Group non-GE (P = 0.018). The 2-year and 4-year survival rates were 82.5% and 70.7% in Group GE, and 71.5% and 59.0% in Group non-GE, respectively.

CONCLUSION

Gastrointestinal endoscopy plays an important role in the early detection and improving the prognosis of pharyngeal SCCs.

Keywords: Gastrointestinal imaging, Head and neck imaging, Gastrointestinal endoscope, Hypopharyngeal neoplasm, Oropharyngeal neoplasm, Endoscopic surgery

Core Tip: This is the first study to explore the detection modality of oropharyngeal and hypopharyngeal squamous cell carcinomas (SCC). In this study, 31.4% of pharyngeal SCCs (15.4% of oropharyngeal SCCs and 42.3% of hypopharyngeal SCCs) were detected by gastrointestinal endoscopy. The clinical characteristics of the lesions detected by gastrointestinal endoscopy include a higher proportion of asymptomatic cases, cTis-1 cases, cases with no lymph node metastasis and cases treated by endoscopic laryngo-pharyngeal surgery/endoscopic submucosal dissection, leading to a better prognosis. This study highlights the important role of gastrointestinal endoscopy in the early detection and treatment of SCC in the otolaryngology field.