Watson R F, Chernock R D, Zhang K H, Michel L S, Adkins D R, El-Mofty S K, Lewis J S
Pathology and Immunology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8118, St Louis, MO, USA.
Head Neck Pathol. 2015 Sep;9(3):360-8. doi: 10.1007/s12105-014-0604-y. Epub 2015 Jan 7.
Spindle cell carcinoma (SpCC) is an uncommon head and neck squamous cell carcinoma (SCC) variant consisting of spindled and/or pleomorphic cells with epithelial differentiation. Epidermal growth factor receptor (EGFR) is expressed by >90 % of conventional SCC, and high level expression is associated with a poorer prognosis. Anti-EGFR therapies are commonly used to treat head and neck SCC. However, no studies have evaluated EGFR expression in SpCC. Cases of SpCC were retrieved from department files. The diagnosis required either a biphasic lesion with a squamous neoplastic component, or a purely spindle cell or pleomorphic tumor with immunohistochemical positivity for epithelial markers. EGFR immunohistochemistry was performed and was quantified in quartiles. Medical records were reviewed for clinical follow up information. EGFR was expressed in 21/30 (70 %) cases, including in the squamous component in 18/19 (95 %) and the spindle cell component in only 12/30 (40 %). Where the spindle cell component was positive, the intensity and distribution were lower than for the squamous component. Recurrent tumors were predominantly (80-90 %) of the spindle cell component, and had low (or absent) EGFR expression. Kaplan-Meier survival analysis showed no statistically significant differences in overall or disease free survival between the EGFR expressing and non-expressing groups (p = 0.414 and 0.19, respectively). SpCCs of the head and neck have a poor prognosis, and markedly reduced EGFR expression. EGFR-specific therapies may not be ideal for SpCC patients, which may lack EGFR expression, but further studies are needed.
梭形细胞癌(SpCC)是一种罕见的头颈部鳞状细胞癌(SCC)变体,由具有上皮分化的梭形和/或多形性细胞组成。超过90%的传统SCC表达表皮生长因子受体(EGFR),高水平表达与较差的预后相关。抗EGFR疗法常用于治疗头颈部SCC。然而,尚无研究评估SpCC中EGFR的表达情况。从科室档案中检索出SpCC病例。诊断需要具备以下条件之一:具有鳞状肿瘤成分的双相性病变,或对上皮标志物免疫组化呈阳性的纯梭形细胞或多形性肿瘤。进行EGFR免疫组化并按四分位数进行量化。查阅病历以获取临床随访信息。30例病例中有21例(70%)表达EGFR,其中19例中的18例(95%)在鳞状成分中表达,仅30例中的12例(即40%)在梭形细胞成分中表达。梭形细胞成分呈阳性时,其强度和分布低于鳞状成分。复发性肿瘤主要(80 - 90%)为梭形细胞成分,且EGFR表达低(或无)。Kaplan - Meier生存分析显示,EGFR表达组和非表达组在总生存期或无病生存期方面无统计学显著差异(分别为p = 0.414和0.19)。头颈部SpCC预后较差,且EGFR表达明显降低。EGFR特异性疗法可能并非SpCC患者的理想选择,这类患者可能缺乏EGFR表达,但仍需进一步研究。