Esophageal squamous cell neoplasm (ESCN), the most common secondary tumor among patients with head and neck squamous cell carcinoma (HNSCC), occurs at a rate of 3%–10% [1] [2]. The occurrence of second primary tumors (SPTs) is one of the major reasons for the lower survival rates in HNSCC patients [3]. High risk factors associated with SPT occurrence have also been identified [3]. In a prospective study conducted by van Tilburg et al., synchronous or metachronous endoscopic screenings were performed in patients with a history of HNSCC, leading to the identification of SPTs in 5% of patients [4]. This research serves as a reminder for endoscopists to enhance their vigilance in observing abnormal lesions in the pharynx and larynx during endoscopic examinations, while also recognizing the importance of timely communication and collaboration with otolaryngologist.

In the van Tilburg et al. study, various imaging modalities, including computed tomography, nasal endoscopy, magnetic resonance imaging, and endoscopy, were used to monitor the occurrence of SPTs following HNSCC [4]. With the rapid development of artificial intelligence today, it is possible to collect diverse imaging data from patients with HNSCC who are at risk of developing SPTs, and to utilize artificial intelligence and machine learning to construct predictive models for related risks. Moreover, microscopic approaches such as microbiome sequencing, blood miRNA detection, and spatial-temporal transcriptomics could be employed to establish multiomic analysis for early prediction of asynchronous or multiple primary cancers.

Additionally, we noted that the exclusion criteria of the study included patients with pharyngeal cancer preceding or concurrent with esophageal cancer [4]. If a risk model were constructed for this subset of patients, it might enable comprehensive prediction of the temporal and spatial sequence of tumor development, including HNSCC. Such comprehensive research would be of significant clinical value, and we eagerly anticipate witnessing such advancements in the future. It would undoubtedly create a groundbreaking impact on the progress of human medicine.

Article published online:
30 January 2024

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