Squamous Dysplasia in the Esophagus Tied to Risk of Additional Lesions

By David Douglas

August 18, 2016

NEW YORK (Reuters Health) - Patients with early-stage esophageal squamous cell carcinomas (SCC) and areas of dysplastic squamous epithelium are at increased risk of developing multiple SCCs, according to Japanese researchers.

However, the extra risk is smaller in people who abstain from alcohol, the team reports in Gastroenterology, online July 18.

As Dr. Manabu Muto told Reuters Health by email, "Multiple development of esophageal SCC is known as field cancerization and its cause has been linked to alcohol consumption."

Squamous dysplasia is believed to be a pre-neoplastic SCC lesion and is easily identified via Lugol chromoendoscopy as a Lugol-voiding lesion (LVL), Dr. Muto of Kyoto University Graduate School of Medicine and colleagues note.

However, they add, "prospective data on the association between the grade of LVL and risk of metachronous SCC are lacking."

To help fill that gap, the researchers prospectively studied 330 patients. Among inclusion criteria were newly diagnosed early SCC of the esophagus, complete endoscopic resection by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) and tumor invasion limited to the mucosa on histopathological examination of resected specimens.

None of the patients had had additional treatment such as surgical resection or radiotherapy immediately after EMR or ESD and they had no active head and neck cancer other than superficial SCC limited to the subepithelial layer.

Lugol chromoendoscopy was used to evaluate dysplastic squamous epithelium in the esophagus. In all, 50 patients had no LVLs, 174 had up to nine and the remaining 106 had 10 or more. Participants also completed lifestyle surveys and were instructed to abstain from alcohol use and smoking.

Over the two-year study period, metachronous SCCs of the esophagus were detected in 4% of patients who originally had had no LVLs, 9.4% of patients with nine or fewer and 24.7% of those with 10 or more. For head and neck SCCs, the corresponding proportions were none, 1.7% and 8.6%.

Further studies are needed, but the investigators observe that "the grade of LVL is a useful predictor of the risk of metachronous multiple SCC arising in the esophagus and the head and neck region in survivors of esophageal cancer."

"Surprisingly," Dr. Muto concluded, "alcohol abstinence dramatically decreased the risk of multiple SCC of the esophagus (adjusted hazard ratio, 0.47), whereas smoking abstinence did not."

SOURCE: http://bit.ly/2aZ7Utf

Gastroenterology 2016.