Aims:
Esophageal squamous cell carcinoma (ESCC) is often accompanied by second primary tumors in the head and neck region. Patients with an additional head and neck second primary tumor (HNSPT) have a worse prognosis than those with only ESCC. Therefore, early detection of HNSPTs may improve the overall outcome of esophageal cancer patients. The aim of this study was to review the literature to investigate the yield of endoscopic head and neck screening to detect HNSPTs in patients with ESCC. Secondary aims were to investigate whether screening should be performed synchronously or metachronously, and to investigate whether there is enough evidence to justify endoscopic screening in the Western world.
Methods:
A systematic literature search was conducted until January 2018 to retrieve studies from Embase, MEDLINE, Web of science, Cochrane Central and Google Scholar. Studies in which ESCC patients were endoscopically screened for the detection of HNSPTs were included. MINORS- and relevance-criteria were used to assess the study quality. The primary outcome was the pooled prevalence of HNSPTs.
Results:
Eight studies were included in this systematic review and meta-analysis with a total of 4295 patients; all studies were performed in Japan. The pooled prevalence of HNSPTs was 5.4% (95% confidence interval (CI) 3.6 – 8.1). The overall heterogeneity (I2= 88%, p < 0.001) was high across the studies. Most SPTs were located in the hypopharynx (59%), classified as low-stage (85%), and detected metachronously (69%).
Conclusions:
Based on our results, the pooled prevalence of HNSPTs was 5.4% (95% CI 3.6 – 8.1). The majority of HNSPTs were classified as low-stage, which can be treated curatively and have an excellent prognosis. Therefore, (metachronous) endoscopic screening could be considered in patients with ESCC. Since all studies were performed in Japan, it is not clear if this consideration applies to the Western world.
