Reddy S P, Raslan W F, Gooneratne S, Kathuria S, Marks J E
Loyola-Hines Department of Radiotherapy, Loyola University Chicago, Maywood, IL 60153, USA.
Am J Otolaryngol. 1995 Mar-Apr;16(2):103-8. doi: 10.1016/0196-0709(95)90040-3.
Keratinization may be a vulnerable aid in predicting response to therapy for nasopharyngeal carcinoma.
The presence or absence of keratin in biopsy specimens was correlated with tumor behavior, locoregional control, patterns of failure, and survival of patients irradiated for nasopharyngeal carcinoma.
Patients with keratinizing squamous-cell cancers (World Health Organization [WHO] type 1) had a higher incidence (76%) of locally advanced tumors than those with nonkeratinizing (WHO type 2) and undifferentiated (WHO type 3) cancers (55%). The former group of patients had a lower incidence (29%) of lymph node metastases than the later group (70%). Primary tumor was controlled in 62% and neck nodes were controlled in 82% of all patients. Primary tumor control rates were 29% in patients with keratinizing squamous-cell cancers and 79% in those with nonkeratinizing and undifferentiated cancers (P = .001). Nodal control rates were 76% for keratinizing squamous-cell cancer and 85% for nonkeratinizing and undifferentiated cancers (P = .001). The incidence of distant metastases was 6% in patients with keratinizing squamous-cell cancer and 33% in those with nonkeratinizing and undifferentiated cancers (P = .001). Patients with keratinizing squamous-cell cancers, even though they had a lower incidence of lymphatic and distant metastases, had a poorer survival rate because of a higher incidence of deaths from uncontrolled primary tumors and nodal metastases. The 5-year survival rates were 35% for all patients, 6% for those with keratinizing squamous-cell cancers, and 51% for nonkeratinizing and undifferentiated cancers respectively (P = .001).
Higher doses of external beam radiotherapy with or without brachytherapy boost may be needed to improve local control and survival of patients with keratinizing squamous-cell carcinoma of the nasopharynx, whereas an effective systemic therapy is needed for nonkeratinizing and undifferentiated cancers, which tend to metastasize.
角化可能是预测鼻咽癌治疗反应的一个薄弱依据。
活检标本中有无角化与鼻咽癌放疗患者的肿瘤行为、局部区域控制、失败模式及生存情况相关。
角化性鳞状细胞癌（世界卫生组织[WHO]1型）患者局部晚期肿瘤的发生率（76%）高于非角化性（WHO 2型）和未分化癌（WHO 3型）患者（55%）。前一组患者的淋巴结转移发生率（29%）低于后一组（70%）。所有患者中，原发肿瘤控制率为62%，颈部淋巴结控制率为82%。角化性鳞状细胞癌患者的原发肿瘤控制率为29%，非角化性和未分化癌患者为79%（P = 0.001）。角化性鳞状细胞癌的淋巴结控制率为76%，非角化性和未分化癌为85%（P = 0.001）。角化性鳞状细胞癌患者的远处转移发生率为6%，非角化性和未分化癌患者为33%（P = 0.001）。角化性鳞状细胞癌患者尽管淋巴和远处转移发生率较低，但由于未控制的原发肿瘤和淋巴结转移导致的死亡率较高，其生存率较低。所有患者的5年生存率分别为35%，角化性鳞状细胞癌患者为6%，非角化性和未分化癌患者为51%（P = 0.001）。
对于鼻咽角化性鳞状细胞癌患者，可能需要更高剂量的外照射放疗联合或不联合近距离放疗增敏来提高局部控制率和生存率，而对于倾向于转移的非角化性和未分化癌，则需要有效的全身治疗。
