Department of Surgery, Albert Einstein Medical Center, Philadelphia, PA.
Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA.
J Am Coll Surg. 2018 Jun;226(6):1086-1092. doi: 10.1016/j.jamcollsurg.2017.10.019. Epub 2017 Nov 11.
Basaloid squamous cell carcinoma (BSC) is a rare variant of squamous cell carcinoma (SqCC) of the esophagus. Even though pathologically thought to be more aggressive than SqCC, there is discrepancy in the literature regarding the outcomes of BSC compared with those of SqCC.
We conducted a retrospective cohort study using the Surveillance Epidemiology and End Results (SEER) database. All patients with a histologic diagnosis of BSC and SqCC between 2004 and 2013 were included. We compared treatment and survival characteristics of patients with BSC and SqCC.
There were 16,158 patients included in this study; 173 patients (1.1%) had BSC. There were no significant differences between the 2 groups based on age, sex, marital status, insurance, or geographic region of diagnosis, but patients with BSC were more likely to be Caucasian (73.4% vs 64.7%; p = 0.017). Among staged patients, baseline tumor stage was similar in both groups. However, BSC tumors were more likely to be of high pathologic grade (56.8% vs 38.2%; p < 0.001). Patients with SqCC were more likely to receive radiation therapy (36.9% vs 53.9%; p < 0.001), while patients with BSC were more likely to undergo resection (32.4% vs 17.0%; p < 0.001). Median overall survival was similar in both groups (14 vs 9 months; log rank = 0.144), and this relationship persisted after stratification by treatment.
Even though more likely to be poorly differentiated at presentation, BSC of the esophagus seems to have similar clinical features and survival outcomes when compared with SqCC. Patients with BSC and SqCC should undergo stage-specific treatment to achieve optimal outcomes.
基底样鳞状细胞癌（BSC）是食管鳞状细胞癌（SqCC）的一种罕见变异。尽管从病理上认为比 SqCC 更具侵袭性，但在 BSC 与 SqCC 的预后比较方面，文献中存在差异。
我们使用监测、流行病学和最终结果（SEER）数据库进行了一项回顾性队列研究。纳入了 2004 年至 2013 年间所有组织学诊断为 BSC 和 SqCC 的患者。我们比较了 BSC 和 SqCC 患者的治疗和生存特征。
本研究共纳入 16158 例患者，其中 173 例（1.1%）为 BSC。两组在年龄、性别、婚姻状况、保险和诊断的地理区域方面无显著差异，但 BSC 患者更可能为白人（73.4% vs 64.7%；p=0.017）。在分期患者中，两组的基线肿瘤分期相似。然而，BSC 肿瘤更可能为高病理分级（56.8% vs 38.2%；p<0.001）。SqCC 患者更可能接受放疗（36.9% vs 53.9%；p<0.001），而 BSC 患者更可能接受切除（32.4% vs 17.0%；p<0.001）。两组的中位总生存期相似（14 与 9 个月；对数秩检验=0.144），且这种关系在按治疗分层后仍然存在。
尽管在发病时更可能分化不良，但与 SqCC 相比，食管 BSC 似乎具有相似的临床特征和生存结局。BSC 和 SqCC 患者应进行特定于分期的治疗以实现最佳结局。
