Colorectal Cancer and Advanced Neoplasia in Patients with Esophageal Squamous Cell Carcinoma: A Retrospective Cohort...

Patients with esophageal squamous cell carcinoma (SCC) may be more likely to harbor colorectal cancer (CRC) because of shared lifestyle risk factors such as smoking and alcohol. However, its prevalence and clinical significance remain unclear. We evaluated prevalence and risk factors for colorectal advanced neoplasia (CAN) and CRC in patients with esophageal SCC and compared them with fecal occult blood test (FOBT)-positive controls.

We retrospectively analyzed 457 patients with esophageal SCC who underwent colonoscopy between 2017 and 2024. CRC was defined as colorectal adenocarcinoma invading submucosal layer or beyond. CAN was defined as ≥10-mm lesion, high-grade dysplasia, villous histology, or CRC. Risk factors were assessed using logistic regression. Propensity score matching (PSM) compared incidence of CAN and CRC with FOBT-positive controls matched for age, sex, and body mass index (caliper=0.05).

Among patients with esophageal SCC, 25.4% had CAN and 10.3% had CRC. Brinkman Index (OR 1.02, 95% CI 1.00-1.04) and alcohol history (OR 2.60, 95% CI 1.13-5.97) were independently associated with CAN (P = 0.048 and 0.025), while no variable was associated with CRC in multivariate analysis. After PSM (135 matched pairs; all standardized mean difference <0.1), CRC incidence remained significantly higher in SCC than FOBT-positive group (OR 3.79 (95% CI 1.21-11.8; P = 0.015)), whereas CAN incidence did not differ.

Patients with esophageal SCC had a higher prevalence of CRC compared with FOBT-positive group after PSM. Lifestyle factors were linked to CAN but not CRC. Colonoscopy should be considered in patients with esophageal SCC.