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Association between continuous cessation or reduction of drinking alcohol and improvement of multiple dysplastic lesions in patients with esophageal squamous cell carcinoma after endoscopic resection

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Abstract

Background

Multiple development of squamous cell carcinoma (SCC) in the upper aerodigestive tract has been explained by the ‘field cancerization phenomenon’ associated with alcohol drinking. Squamous dysplastic lesion is clinically visualised as a Lugol-voiding lesion (LVL) by chromoendoscopy. Whether cessation or reduction of alcohol drinking improves multiple LVL and reduces the risk of field cancerization has not been elucidated.

Methods

We analysed 330 patients with newly diagnosed superficial esophageal SCC (ESCC) enrolled in the cohort study. The grade of LVL was assessed in all patients every 6 months. We instructed the patients to stop smoking and drinking and recorded their drinking and smoking status every 6 months.

Results

Among 330 patients, we excluded 98 with no LVL or no drinking habit. Of the remaining 232 patients, 158 continuously ceased or reduced their drinking habit. Patients who ceased or reduced their drinking habit significantly showed improvement in the grade of LVL. Multivariate analysis showed that continuous cessation or reduction of drinking habit improved the grade of LVL (hazard ratio [HR] = 8.5, 95% confidence interval [CI] 1.7–153.8, p = 0.0053). Higher grade of LVL carried a high risk of multiple ESCC and head and neck SCC (HNSCC) (HR = 3.7, 95% CI 2.2–6.4, p < 0.0001). Improvement in LVL significantly decreased the risk of multiple ESCC and HNSCC (HR = 0.2, 95% CI 0.04–0.7, p = 0.009).

Conclusions

This is the first report indicating that field cancerization was reversible and cessation or reduction of drinking alcohol could prevent multiple squamous dysplastic lesion and multiple ESCC and HNSCC development.

Clinical trials registry number

UMIN000001676.

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Data availability

Data are available on reasonable request. The data that support the findings of this study have been deposited in UMIN (https://www.umin. ac. jp/ icdr/ index. html), and the data are available from the corresponding author, CK, on reasonable request.

Abbreviations

ESCC:

Esophageal squamous cell cancer

HNSCC:

Head and neck squamous cell carcinoma

UAT:

Upper aerodigestive tract

LVL:

Lugol-voiding lesions

NBI:

Narrow-band imaging

SCC:

Squamous cell carcinoma

HR:

Hazard ratio

CI:

Confidence interval

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Acknowledgements

We would like to thank all the investigators who cooperated in recruiting patients all participating institutions, Minae Nishiguchi and Naomi Kusaka who supported data management at the Medical research support (Osaka, Japan). We would like to thank editage (www. editage. jp) for the English language review.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan

    Keisuke Hori & Hiroyuki Okada

  2. Department of Internal Medicine, Tsuyama Chuo Hospital, Tsuyama, Japan

    Keisuke Hori

  3. Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho Syhogoin Sakyo, Kyoto, 606-8507, Japan

    Chikatoshi Katada & Manabu Muto

  4. Department of Real World Data Research and Development, Graduate School of Medicine, Kyoto University, 54 Kawaharacho Syhogoin Sakyo, Kyoto, 606-8507, Japan

    Chikatoshi Katada

  5. Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Japan

    Hiroyuki Okada

  6. Department of Medicine, Division of Gastroenterology, Showa University Hospital, Tokyo, Japan

    Atsushi Katagiri

  7. Department of Gastroenterology, St. Marianna University School of Medicine, Kawasaki, Japan

    Yasumasa Matsuo

  8. Department of Health and Promotion, National Institute of Public Health, Wako, Japan

    Tetsuji Yokoyama

  9. Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan

    Tomonori Yano

  10. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

    Haruhisa Suzuki

  11. Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Yuichi Shimizu

  12. Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan

    Yasuaki Furue

  13. Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan

    Hiroyoshi Nakanishi

  14. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Tomoyuki Koike

  15. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan

    Kohei Takizawa

  16. Department of Endoscopy, Koyukai Shin-Sapporo Hospital, Hokkaido, Japan

    Kohei Takizawa

  17. Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan

    Motohiro Hirao

  18. Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan

    Takako Yoshii

  19. Department of Gastroenterology, Kumamoto Regional Medical Center, Kumamoto, Japan

    Takenori Yamanouchi

  20. Department of Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan

    Hirofumi Kawakubo

  21. Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan

    Nozomu Kobayashi

  22. Division of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan

    Tadakazu Shimoda

  23. Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan

    Atsushi Ochiai

  24. Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Hideki Ishikawa

  25. Clinical Research Unit, National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Japan

    Akira Yokoyama

Authors
  1. Keisuke Hori
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  2. Chikatoshi Katada
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Contributions

KH, CK, HO and MM contributed to the study design, drafting, and manuscript writing. KH, CK, AK, YM, TY, HS, YS, YF, HN, TK, KT, MH, TY, TY, HK, NK, TS, AO, AY and MM contributed to data collection and interpretation. HI and TY contributed to data analysis. HO, CK and MM gave final approval of the manuscript. All authors contributed to the revision of the manuscript and approved the final draft submitted.

Corresponding author

Correspondence to Chikatoshi Katada.

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Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

Conflict of interests

Authors declare no conflicts of interest for this article. This study was supported by a grant from National Cancer Center Research and Development Fund 36 by the Ministry of Health, Labour and Welfare of Japan. The sponsor had no role in the design of the study, data collection, analysis, and interpretation, writing of the manuscript, or decision to submit for publication. The sponsor had no access to raw data. All authors have access to the raw data. The corresponding author has full access to all the data and the final responsibility to submit for publication.

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Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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Hori, K., Katada, C., Okada, H. et al. Association between continuous cessation or reduction of drinking alcohol and improvement of multiple dysplastic lesions in patients with esophageal squamous cell carcinoma after endoscopic resection. Esophagus 21, 31–40 (2024). https://doi.org/10.1007/s10388-023-01033-9

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