Continuously cessation or reduction of drinking habit improves the Lugol Voiding Lesions in patients of esophageal squamous cell carcinoma after endoscopic resection Keisuke Hori* 1, Hiroyuki Okada1, Kazuo Konishi2, Takashi Tsuda3, Chikatoshi Katada4, Tetsuji Yokoyama5, Kazuhiro Kaneko6, Ichiro Oda7, Yuichi Shimizu8, Hisashi Doyama9, Tomoyuki Koike10, Kohei Takizawa11, Motohiro Hirao12, Takako Yoshii13, Takenori Yamanouchi14, Tai Omori15, Nozomu Kobayashi16, Tadakazu Shimoda7, Atsushi Ochiai6, Hideki Ishikawa17, Akira Yokoyama18, Manabu Mutou19 1. Okayama University Hospital, 2. Showa University, 3. St. Marianna University, 4. Kitasato University, 5. National Institute of Public Health, 6. National Cancer Center Hospital East, 8. Hokkaido University, 9. Ishikawa Prefectural Central Hospital, 10. Tohoku University, 11. Shizuoka Cancer Center, 12. Osaka National Hospital, 13. Kanagawa Cancer Center, 14. Kumamoto Regional Medical Center, 15. Keio University, 16. Tochigi Cancer Center, 17. Kyoto Prefectural University of Medicine, 18. Kurihama Alcoholsho Center, 19. Kyoto University, JAPAN
Esophageal squamous-cell carcinomas (ESCC) have a high incidence of multiple ESCCs. Lugol-voiding lesions (LVLs) recognized by using iodine chromoendoscopy were reported to be precursors for multiple primary cancers in the esophagus associated with the “field cancerrization phenomenon”. LVLs are highly associated with alcohol abuse.
2. At study entry, drinking and smoking histories and dietary habits were recorded using self-assessed questionnaire. 3. All patients were instructed to abstain from smoking and drinking alcohol. 4. After endoscopic treatment, all patients were prospectively followed up by iodine chromoendoscopy every six months with record of LVLs, drinking and smoking habit. Associations between improvement of LVLs and change of drinking habit are analyzed.
AIMS The aims of this study were to assess the improvement of LVLs according to abstinence or reduction of drinking alcohol after the initial endoscopic treatment for ESCCs.
Grade A
PATIENTS On 331 patients with newly diagnosed ESCC, who underwent endoscopic mucosal resection or endoscopic submucosal dissection between September 2005 and May 2010 were registered to this prospective cohort study.
METHODS
Grade B
Grade C
(n=143/183) (drinker/all)
(n=89/93) (drinker/all)
(n=26/55) (drinker/all)
Grade B
Grade C
multiple LVLs10≤
Continue drinking
80 60 40 Log rank p=0.031
20
Instruction to abstain from drinking
Grade B 9/143 (6%) All P at ie n t s, n
232
Age (ye ar s) S e x, n (% ) LVLs, n (% )
6 6 (4 7 - 8 8 )
100
48 Month
24
0
96
72
LVLs non-improved group LVLs improved group
80 60 Log rank p=0.089
40
Wilcoxon p=0.045
20 0
Table 2. Associations between habitual records and improvement of LVLs
Grade C 10/89 (11%)
U ni v a ri a te a na l y s i s HR 95% CI p v a l ue
I mpr o ve me n t o f LVLs Ye s No 19 213
48 Month
24
0
72
96
6 8 (5 8 - 8 1 )
6 6 (4 7 - 8 8 )
0 .5 3
1 3 (5 .6 ) 2 1 9 (9 4 .4 )
0 (0 ) 1 9 (1 0 0 )
1 3 (6 .1 ) 2 0 0 (9 3 .9 )
A B C
0 1 4 3 (6 2 .0 ) 8 9 (3 8 .0 )
0 9 (4 7 .3 ) 1 0 (5 2 .6 )
0 1 3 4 (6 2 .9 ) 7 9 (3 7 .1 )
0 .2 2
4 (1 - 5 )
4 (3 - 5 )
4 (1 - 5 )
0 .3 8
0 .6 1
S mo kin g h abit be fo r e EMR (pac k ye ar s)
4 4 (0 - 1 7 5 )
5 7 (0 - 8 4 )
4 4 (0 - 1 7 5 )
0 .4 0
Dr in kin g h abit be fo r e EMR (u n it s/ day)
2 .3 (0 .2 - 1 3 .6 )
2 .6 (0 .8 - 1 3 .6 )
2 .3 (0 .2 - 1 0 .4 )
0 .4 8
7 1 （ 3 0 .6 ） 1 6 1 （ 6 9 .4 ）
Co n t in u o u s c e ssat io n o r r e du c t io n o f dr in kin g No 7 4 (3 1 .9 ) Ye s 1 5 8 (6 8 .1 )
4 (2 1 .1 ) 1 5 (7 8 .9 ) 2 (1 0 .5 ) 1 7 (8 9 .5 )
6 7 (3 1 .5 ) 1 4 6 (6 8 .5 ) 7 2 (3 4 .0 ) 1 4 1 (6 6 .0 )
LV Ls
B C
1.0 1.7
Green-y el l ow v eg eta bl es * ≤ 3 > 3
1.0 1.7
Smok i ng ha bi t bef ore E MR ≤ 44 pa ck y ea r > 44 pa ck y ea r
1.0 2.2
D ri nk i ng ha bi t bef ore E MR ≤ 2.3 uni ts /da y > 2.3 uni ts /da y
1.0 2.0
( 0.7-4.2)
Mul ti v a ri a te a na l y s i s H R 95% CI p v a l ue
0.26
1.0 1.4
0.29
1.0 1.3
( 0.5-4.1)
0.64
0.17
1.0 2.8
( 1.0-9.0)
0.046
0.13
1.0 1.8
( 0.7-5.3)
0.26
0.33
1.0 2.1
( 0.7-9.4)
0.23
0.018
1.0 8.5
( 1.7-153.8)
( 0.5-3.8)
0.47
0 .3 3
Conti nuous a bs tra i n f rom s mok i ng No 1.0 Yes 1.7
( 0.6-5.4)
( 0.9-6.2)
( 0.8-5.8)
( 0.6-5.9)
Conti nuous ces s a ti on or reducti on of dri nk i ng No 1.0 Yes 4.4 ( 1.2-27.5)
0.005
6 0 (2 5 .9 ) 1 7 2 (7 4 .1 )
2 (1 0 .5 ) 1 7 (8 9 .5 )
5 8 (2 7 .2 ) 1 5 5 (7 2 .8 )
Un ivariate an alysis HR 9 5 % CI p valu e LVLs
B C
1 .0 3 .2
Improve me n t of LVls No 1 .0 Ye s 0 .3
Mu ltivariate an alysis HR 9 5 % CI p valu e
(1 .9 - 5 .6 ) ＜0 .0 0 0 1
1 .0 3 .4
(2 .0 - 5 .9 )
(0 .0 5 - 1 .0 ) 0 .0 5 1
1 .0 0 .3
(0 .0 5 - 0 .9 )
＜0 .0 0 0 1
0 .0 3 8
CONCLUSION By the continuously cessation or reduction of drinking alcohol, LVLs were significantly improved. To prevent metachronous multiple occurrences of ESCCs, continuous instruction to abstain from the drinking habit is needed.
0 .0 4 * Green-yellow vegetables; 1: seldom, 2: 1-2days/month, 3: 1-2days/week, 4: 3-4 days/week, 5: almost every day
Me t ac h r o n o u s c an c e r No Ye s
Table 3. Associations between improvement of LVLs and metachronous ESCC
p valu e
Fe male Male
Co n t in u o u s abst r ain fr o m smo kin g No Ye s
1≤LVLs<10
Continuous cessation or reduction of drinking
Improvement of LVLs
Gr e e n - ye llo w ve ge t able s*
no LVLs
100
0
Table 1. Clinical characteristics of patients according to improvement of LVLs
1. At initial diagnosis of ESCC, patients were examined by iodine chromoendoscopy and assessed the extent of LVLs according to the number of LVLs per endoscopic view.
Grade A
RESULTS
Figure 2. Cumulative incidence of metachronous ESCC
Figure 1. Cumulative rate of improvement of LVLs
Cumulative incidence (%)
METHODS (Cont.)
Cumulative incidence (%)
Introduction
0 .1 6
COI All authors disclosed no financial relationships to this study.
