Contents lists available at ScienceDirect Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology Clinical benefits from endoscopy screening of esophageal second primary tumor for head and neck cancer patients: Analysis of a hospital-based registry Chen-Shuan Chung a,b , Wu-Chia Lo c , Kuan-Chih Chen a , Cheng-Lu Lin a , Ming-Hsun Wen c , Chen-Hsi Hsieh d,e,f , Shih-Chiang Lin g , Li-Jen Liao c,h, ⁎ a Division of Gastroenterology and Hepatology, g Division of Medical Oncology and Hematology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan b College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan c Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan d Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan e Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan f Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan g Department of Oncology & Hematology, Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan h Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan ARTICLE INFO Keywords: Second primary tumor Head and neck cancer Esophageal cancer Image-enhanced endoscopy Field cancerization ABSTRACT Objectives: Esophageal second primary tumors (SPTs) in head and neck cancer (HNC) patients is not uncommon. The impact of image-enhanced endoscopy (IEE) screening for esophageal SPT on the outcome of HNC patients has not been well clarified. Methods and methods: Patients with malignancies of the head and neck region and esophagus were recruited from a hospital-based cancer registry between July 2000–December 2016. IEE screening included magnifying endoscopy with narrow-band imaging and chromoendoscopy with Lugol's solution. Biopsied specimens with revised Vienna classification categories 1 and 2 were defined as group I, and those with categories 3 to 5 were defined as group II. The Kaplan-Meier estimate and Cox regression model were used for survival analysis. Results: Totally 1577 HNC and 501 esophageal cancer patients were enrolled. The 5-year overall survival (OS) rates of stage I/II HNC, stage III/IV HNC and esophageal cancer patients were 58%, 29%, and 8%, respectively (p < 0.01). The 5-year OS rate of HNC patients with negative IEE results was higher than that of HNC patients without IEE screening, followed by IEE screening groups I, II and esophageal cancer patients (44% vs. 39% vs. 35% vs. 11% vs. 8%, respectively, p for trend < 0.01). Among advanced HNC patients, those who received IEE screening had a trend of better prognosis than those without screening (5-year OS rate of 31% vs. 28%, p = 0.17). Conclusions: IEE screening for esophageal SPTs is helpful in risk stratification and prognosis prediction for HNC patients. Routine IEE screening is recommended in HNC patients. Introduction The occurrence of synchronous second primary tumors (SPTs), which is associated with a higher mortality rate, is not uncommon in head and neck cancer (HNC) patients, where the incidence of SPTs ranges between 7–36% [1–5]. The most common sites of SPTs are the esophagus, the head/neck region and the lungs, and they can develop synchronously or metachronously with the index primary malignancies https://doi.org/10.1016/j.oraloncology.2019.06.038 Received 11 March 2019; Received in revised form 31 May 2019; Accepted 29 June 2019 Abbreviations: AJCC, the American Joint Committee on Cancer; CI, confidence interval; CIS, carcinoma in situ; DSS, disease-specific survival; ESD, endoscopic submucosal dissection; ESCN, esophageal squamous cell neoplasia; FEMH, Far Eastern Memorial Hospital; HR, hazard ratio; HNC, head and neck cancer; HGIN, high- grade intraepithelial neoplasia; IEE, image-enhanced endoscopy; IPCL, intraepithelial papillary capillary loop; LGIN, low-grade intraepithelial neoplasia; ME, magnifying endoscopy; NBI, narrow-band imaging; OS, overall survival; SPT, second primary tumor; WLI, white-light imaging ⁎ Corresponding author at: Department of Otolaryngology, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Section 2, Banqiao District, New Taipei City 22060, Taiwan. E-mail address: dtent87@gmail.com (L.-J. Liao). Oral Oncology 96 (2019) 27–33 1368-8375/ © 2019 Elsevier Ltd. All rights reserved. T