Winzenburg S M, Niehans G A, George E, Daly K, Adams G L
University of Minnesota, Minneapolis and the Veteran's Administration Medical Center, 55407, USA.
Otolaryngol Head Neck Surg. 1998 Nov;119(5):471-5. doi: 10.1016/S0194-5998(98)70104-4.
Basaloid squamous carcinoma (BSC) of the head and neck has been shown to have a poor prognosis when compared with conventional squamous cell carcinoma (SCC). Pathologically, specimens determined to be BSC can have nearly pure basaloid features (group 1) or a mixture of basaloid and squamous features (group 2). The clinical behavior in these 2 subgroups has not been compared previously. BSC is also commonly confused histologically with poorly differentiated SCC (PDSCC). A retrospective comparison of disease stage at presentation, rate of distant metastasis, rate of local recurrence in those offered surgical resection, and rate of survival is made to compare outcomes of the 2 BSC groups and the PDSCC group. The presence of particular histologic features may be associated with poorer outcomes. Patients with BSC have advanced disease at presentation. Survival in the BSC group was less than half that in the PDSCC groups. Statistical analysis shows the 2 groups to be well matched with regard to stage and site of disease. Presence of neck nodal disease on presentation predicts poor survival. In this study distant metastases occurred in 52% of patients with BSC and in 13% of patients in the PDSCC group. The local recurrence rate is comparable for BSC and conventional SCC, with even early tumors in the BSC group recurring distantly rather than locally or regionally. Considering the high distant metastatic rate of BSC and poorer overall survival rate, a more extensive metastatic survey is indicated in these patients before surgery is recommended. We recommend that patients with a diagnosis of BSC not be included with conventional SCC groups in prospective randomized cancer protocols.
与传统鳞状细胞癌（SCC）相比，头颈部基底样鳞状细胞癌（BSC）的预后较差。在病理上，被判定为BSC的标本可具有几乎纯的基底样特征（第1组）或基底样和鳞状特征的混合（第2组）。此前尚未对这两个亚组的临床行为进行比较。在组织学上，BSC也常与低分化SCC（PDSCC）混淆。对就诊时的疾病分期、远处转移率、接受手术切除患者的局部复发率以及生存率进行回顾性比较，以比较两个BSC组和PDSCC组的结果。特定组织学特征的存在可能与较差的预后相关。BSC患者就诊时病情已进展。BSC组的生存率不到PDSCC组的一半。统计分析表明，两组在疾病分期和部位方面匹配良好。就诊时存在颈部淋巴结疾病预示着生存率低。在本研究中，52%的BSC患者发生远处转移，而PDSCC组为13%。BSC和传统SCC的局部复发率相当，甚至BSC组的早期肿瘤也会远处复发，而非局部或区域复发。鉴于BSC的高远处转移率和较差的总体生存率，在建议手术前，应对这些患者进行更广泛的转移情况检查。我们建议，在前瞻性随机癌症方案中，不应将诊断为BSC的患者纳入传统SCC组。
