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Background <p>The presence of multiple Lugol-voiding lesions (LVLs) in the esophagus and pharynx is indicative of an increased risk for metachronous cancer. However, it is unclear whether esophageal LVLs can predict the development of head and neck squamous cell carcinoma (HNSCC).</p> Methods <p>This retrospective observational study focused on patients who underwent transoral surgery for hypopharyngeal squamous cell carcinoma. Endoscopic images were categorized into three groups based on the number of unstained lesions in the pharyngeal mucosa: Group A had no lesions, Group B had 1 to 4 lesions, and Group C had 5 or more lesions per endoscopic view. Similarly, esophageal unstained lesions were classified into three groups based on the number of Lugol-unstained lesions: Group A had no lesions, Group B had 1 to 9 lesions, and Group C had 10 or more lesions.</p> Results <p>A total of 313 patients were included in the study. Among them, 157 patients (50.2%) had matching grades between pharyngeal and esophageal LVLs. The concordance between esophageal and pharyngeal LVL grades was weak (κ = 0.21, 95% confidence interval [CI]: 0.125–0.295, <i>p</i> &lt; 0.001). The 3-, 5-, and 10-year cumulative incidences of metachronous HNSCC in esophageal LVL grades A, B, and C were 25.9%, 23.2%, and 21.5%; 35.2%, 33.2%, and 33.2%; and 51.4%, 48.6%, and 52.0%, respectively (log-rank test, <i>p</i> = 0.99). In a multivariate Cox regression analysis, esophageal LVL grade was not significantly associated with the development of metachronous HNSCC (hazard ratio: 0.76, 95% CI: 0.51–1.14, <i>p</i> = 0.182).</p> Conclusions <p>Pharyngeal, rather than esophageal, LVLs serve as a more reliable indicator of metachronous HNSCC risk in patients with primary hypopharyngeal cancer.</p>

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Lack of predictive value of esophageal multiple lugol-voiding lesions for metachronous head and neck cancer in patients undergoing transoral surgery for superficial hypopharyngeal cancer

  • 期刊论文

  • 发表日期：

    2026年2月12日

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  • Masaki Inoue,
  • Akihito Watanabe,
  • Yuichi Shimizu,
  • Kenichi Goda,
  • Yuki Kimura,
  • Suguru Ito,
  • Keiko Yamamoto,
  • Shoko Ono,
  • Naoya Sakamoto

摘要

Background

The presence of multiple Lugol-voiding lesions (LVLs) in the esophagus and pharynx is indicative of an increased risk for metachronous cancer. However, it is unclear whether esophageal LVLs can predict the development of head and neck squamous cell carcinoma (HNSCC).

Methods

This retrospective observational study focused on patients who underwent transoral surgery for hypopharyngeal squamous cell carcinoma. Endoscopic images were categorized into three groups based on the number of unstained lesions in the pharyngeal mucosa: Group A had no lesions, Group B had 1 to 4 lesions, and Group C had 5 or more lesions per endoscopic view. Similarly, esophageal unstained lesions were classified into three groups based on the number of Lugol-unstained lesions: Group A had no lesions, Group B had 1 to 9 lesions, and Group C had 10 or more lesions.

Results

A total of 313 patients were included in the study. Among them, 157 patients (50.2%) had matching grades between pharyngeal and esophageal LVLs. The concordance between esophageal and pharyngeal LVL grades was weak (κ = 0.21, 95% confidence interval [CI]: 0.125–0.295, p < 0.001). The 3-, 5-, and 10-year cumulative incidences of metachronous HNSCC in esophageal LVL grades A, B, and C were 25.9%, 23.2%, and 21.5%; 35.2%, 33.2%, and 33.2%; and 51.4%, 48.6%, and 52.0%, respectively (log-rank test, p = 0.99). In a multivariate Cox regression analysis, esophageal LVL grade was not significantly associated with the development of metachronous HNSCC (hazard ratio: 0.76, 95% CI: 0.51–1.14, p = 0.182).

Conclusions

Pharyngeal, rather than esophageal, LVLs serve as a more reliable indicator of metachronous HNSCC risk in patients with primary hypopharyngeal cancer.