Dietary risk factors for upper aerodigestive tract cancers

We examined the association between whole-grain intake and incident upper aerodigestive tract cancer in a cohort of 34,651 postmenopausal, initially cancer-free women. We also studied established risk factors for upper aerodigestive cancers, including fruit and vegetable intake, smoking and alcohol intake. A mailed questionnaire at baseline in 1986 included a food-frequency questionnaire and assessment of other cancer risk factors. During the 14-year follow-up period, 169 women developed cancer of the upper aerodigestive tract. For all upper aerodigestive cancers together, significant inverse associations were observed for the highest compared to the lowest tertile of whole grains [relative risk (RR) = 0.53, 95% confidence interval (CI) 0.34-0.81] and yellow/orange vegetables (RR = 0.58, 95% CI 0.39-0.87). In addition, those in the highest compared to lowest tertile of fiber intake from whole grain were less likely to develop upper aerodigestive tract cancer (RR = 0.56, 95% CI 0.37-0.84); fiber intake from refined grain was not significantly associated with upper aerodigestive tract cancer. Findings were generally similar for oropharyngeal (n = 53), laryngeal (n = 21), nasopharyngeal/salivary (n = 18), esophageal (n = 21) and gastric (n = 56) cancers, though numbers of cases were too small for statistical testing within individual cancers. These findings confirm previous observations that high intake of fruits and vegetables and that intake of whole grains and the fiber derived from them may reduce risk of upper aerodigestive tract cancers.     

Association of common polymorphisms in inflammatory genes with risk of developing cancers of the upper aerodigestive tract

Objectives The purpose of this study was to investigate the role of polymorphisms of genes involved in inflammation in the risk of cancers of the upper aerodigestive tract (UADT). Methods We have evaluated the role of polymorphisms in key genes related to inflammation, namely IL1B (rs1143627), COX2/PTGS2 (rs5275), and IL8 (rs4073) in a large case–control study comprising 811 UADT cancer cases and 1,083 controls. Results An association was observed for squamous cell carcinoma of the pharynx for a polymorphism in the promoter of the IL1B gene, with an OR of 2.39 (95% CI = 1.19–4.81) for the homozygotes for the minor allele A promoter polymorphism of IL8 was associated with decreased risk of laryngeal cancer, with an OR of 0.70 (95% CI = 0.50–0.98) for carriers of the minor allele. Conclusions To our knowledge, this is the first report on the role of these polymorphisms with respect to UADT carcinogenesis. Our results suggest that inflammation-related polymorphisms play a role, albeit minor, in the risk of developing cancers of the upper aerodigestive tract.     

Socioeconomic factors associated with risk of upper aerodigestive tract cancer in Europe

IntroductionIn the European Union, there are 180,000 new cases of upper aerodigestive tract (UADT) cancer cases per year – more than half of whom will die of the disease. Socioeconomic inequalities in UADT cancer incidence are recognised across Europe. We aimed to assess the components of socioeconomic risk both independently and through their influence on the known behavioural risk factors of smoking, alcohol consumption and diet.Patients and methodsA multicentre case–control study with 2198 cases of UADT cancer and 2141 controls from hospital and population sources was undertaken involving 14 centres from 10 countries. Personal interviews collected information on demographics, lifetime occupation history, smoking, alcohol consumption and diet. Socioeconomic status was measured by education, occupational social class and unemployment. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using unconditional logistic regression.ResultsWhen controlling for age, sex and centre significantly increased risks for UADT cancer were observed for those with low versus high educational attainment OR = 1.98 (95% CI 1.67, 2.36). Similarly, for occupational socioeconomic indicators – comparing the lowest versus highest International Socio-Economic Index (ISEI) quartile for the longest occupation gave OR = 1.60 (1.28, 2.00); and for unemployment OR = 1.64 (1.24, 2.17). Statistical significance remained for low education when adjusting for smoking, alcohol and diet behaviours OR = 1.29 (1.06, 1.57) in the multivariate analysis. Inequalities were observed only among men but not among women and were greater among those in the British Isles and Eastern European countries than in Southern and Central/Northern European countries. Associations were broadly consistent for subsite and source of controls (hospital and community).ConclusionSocioeconomic inequalities for UADT cancers are only observed among men and are not totally explained by smoking, alcohol drinking and diet.     

The usefulness of pretreatment DNCB in 85 patients with squamous cell carcinoma of the upper aerodigestive tract

Pretreatment DNCB skin testing and absolute lymphocyte counts were studied in 85 consecutive head and neck cancer patients. All patients were treated primarily with radiation therapy alone or combined radiation plus surgery. The results of DNCB testing and absolute lymphocyte counts were not sufficiently predictive of outcome, (no evidence of disease after 2 years) to be useful in making treatment decisions on an individual patient. This applied to the good prognosis (T1, T2, N0-N3) and poor prognosis (T3, T4, N0-N3) groups.     

Lifetime risk of distinct upper aerodigestive tract cancers and consumption of alcohol,betel and cigarette

The cancer of upper aerodigestive tract (UADT) is a common cancers in the world. However, its lifetime risk by consumption of alcohol, betel and cigarettes remain to be elucidated. This study aimed to estimate lifetime risk of distinct UADT cancers and assess their associations with alcohol, betel and cigarette consumption. Three cohorts of 25,611 men were enrolled in 1982–1992 in Taiwan. The history of alcohol, betel and cigarette consumption was enquired through questionnaire interview. Newly developed UADT cancers were ascertained through computerized linkage with national cancer registry profile. Lifetime (30–80 years old) risk and multivariate‐adjusted hazard ratio (HR_adj) of distinct UADT cancers by alcohol, betel and cigarette consumption were estimated. A total of 269 pathologically confirmed cases of UADT cancers were newly‐diagnosed during 472,096 person‐years of follow‐up. The lifetime risk of UADT cancer was 9.42 and 1.65% for betel chewers and nonchewers, 3.22 and 1.21% for cigarette smokers and nonsmokers and 4.77 and 1.85% for alcohol drinkers and nondrinkers. The HR_adj (95% confidence interval) of developing UADT cancer was 3.36 (2.51–4.49), 2.02 (1.43–2.84), 1.90 (1.46–2.49), respectively, for the consumption of betel, cigarette and alcohol. Alcohol, betel and cigarette had different effect on cancers at various anatomical sites of UADT. The cancer risk from the mouth, pharynx, esophagus to larynx increased for alcohol and cigarette consumption, but decreased for betel consumption. Alcohol, betel and cigarette consumption are independent risk predictors for distinct UADT cancers.     

Case‐control study of cumulative cigarette tar exposure and lung and upper aerodigestive tract cancers

The development of comprehensive measures for tobacco exposure is crucial to specify effects on disease and inform public health policy. In this population‐based case‐control study, we evaluated the associations between cumulative lifetime cigarette tar exposure and cancers of the lung and upper aerodigestive tract (UADT). The study included 611 incident cases of lung cancer; 601 cases of UADT cancers (oropharyngeal, laryngeal and esophageal cancers); and 1,040 cancer‐free controls. We estimated lifetime exposure to cigarette tar based on tar concentrations abstracted from government cigarette records and self‐reported smoking histories derived from a standardized questionnaire. We analyzed the associations for cumulative tar exposure with lung and UADT cancer, overall and according to histological subtype. Cumulative tar exposure was highly correlated with pack‐years among ever smoking controls (Pearson coefficient = 0.90). The adjusted odds ratio (95% confidence limits) for the estimated effect of about 1 kg increase in tar exposure (approximately the interquartile range in all controls) was 1.61 (1.50, 1.73) for lung cancer and 1.21 (1.13, 1.29) for UADT cancers. In general, tar exposure was more highly associated with small, squamous and large cell lung cancer than adenocarcinoma. With additional adjustment for pack‐years, positive associations between tar and lung cancer were evident, particularly for small cell and large cell subtypes. Therefore, incorporating the composition of tobacco carcinogens in lifetime smoking exposure may improve lung cancer risk estimation. This study does not support the claim of a null or inverse association between “low exposure” to tobacco smoke and risk of these cancer types.     

Oral health,dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: The ARCAGE study

ObjectiveWe aimed to assess the association of oral health (OH), dental care (DC) and mouthwash with upper-aerodigestive tract (UADT) cancer risk, and to examine the extent that enzymes involved in the metabolism of alcohol modify the effect of mouthwash.Materials and methodsThe study included 1963 patients with incident cancer of the oral cavity, oropharynx, hypopharynx, larynx or esophagus and 1993 controls. Subjects were interviewed about their oral health and dental care behaviors (which were converted to scores of OH and DC respectively), as well as smoking, alcohol drinking, diet, occupations, medical conditions and socio-economic status. Blood samples were taken for genetic analyses. Mouthwash use was analyzed in relation to the presence of polymorphisms of alcohol-metabolizing genes known to be associated with UADT. Adjusted odds ratios (ORs) and 95%-confidence intervals [CI] were estimated with multiple logistic regression models adjusting for multiple confounders.ResultsFully adjusted ORs of low versus high scores of DC and OH were 2.36[CI = 1.51–3.67] and 2.22[CI = 1.45–3.41], respectively, for all UADT sites combined. The OR for frequent use of mouthwash use (3 or more times/day) was 3.23[CI = 1.68–6.19]. The OR for the rare variant ADH7 (coding for fast ethanol metabolism) was lower in mouthwash-users (OR = 0.53[CI = 0.35–0.81]) as compared to never-users (OR = 0.97[CI = 0.73–1.29]) indicating effect modification (p_{heterogeneity} = 0.065) while no relevant differences were observed between users and non-users for the variant alleles of ADH1B, ADH1C or ALDH2.ConclusionsPoor OH and DC seem to be independent risk factors for UADT because corresponding risk estimates remain substantially elevated after detailed adjustment for multiple confounders. Whether mouthwash use may entail some risk through the alcohol content in most formulations on the market remains to be fully clarified.     

新辅助放化疗联合手术治疗食管鳞癌预后因素分析

目的 分析影响食管鳞癌新辅助放化疗联合手术患者预后相关因素。方法 回顾分析2007—2014年行新辅助放化疗联合手术的74例T_3-4N_0-1M₀期食管鳞癌患者资料,Ⅱ期26例,Ⅲ期48例。Kaplan-Meier法计算OS率并Logrank法检验和单因素分析,Cox模型多因素分析。结果TRG₁,TRG₂,TRG₃级的1、3年OS率分别为86%、50%,85%、50%,94%、86%(P=0.049)。pCR和非pCR者1、3年OS率分别为94%、87%和85%、52%(P=0.015)。淋巴结阴性和阳性1、3年OS率分别为97%、61%和57%、36%(P=0.015)。降期和非降期1、3年OS率分别为93%、70%和67%、17%(P=0.000)。多因素分析显示淋巴结状态及是否降期是影响预后因素(P=0.028、0.015)。结论 术后肿瘤缓解反应分级与患者预后密切相关,尤其pCR者可明显提高患者生存。淋巴结状态及是否降期是影响患者生存因素。     

Revisit of field cancerization in squamous cell carcinoma of upper aerodigestive tract: better risk assessment with epigenetic markers

We quantified field cancerization of squamous cell carcinoma in the upper aerodigestive tract with epigenetic markers and evaluated their performance for risk assessment. Methylation levels were analyzed by quantitative methylation-specific PCR of biopsied specimens from a training set of 255 patients and a validation set of 224 patients. We also measured traditional risk factors based on demographics, lifestyle, serology, genetic polymorphisms, and endoscopy. The methylation levels of four markers increased stepwise, with the lowest levels in normal esophageal mucosae from healthy subjects without carcinogen exposure, then normal mucosae from healthy subjects with carcinogen exposure, then normal mucosae from cancer patients, and the highest levels were in cancerous mucosae (P < 0.05). Cumulative exposure to alcohol increased methylation of homeobox A9 in normal mucosae (P < 0.01). Drinkers had higher methylation of ubiquitin carboxyl-terminal esterase L1 and metallothionein 1M (P < 0.05), and users of betel quid had higher methylation of homeobox A9 (P = 0.01). Smokers had increased methylation of all four markers (P < 0.05). Traditional risk factors allowed us to discriminate between patients with and without cancers with 74% sensitivity (95% CI: 67%-81%), 74% specificity (66%-82%), and 80% area under the curve (67%-91%); epigenetic markers in normal esophageal mucosa had values of 74% (69%-79%), 75% (67%-83%), and 83% (79%-87%); and both together had values of 82% (76%-88%), 81% (74%-88%), and 91% (88%-94%). Epigenetic markers done well in the validation set with 80% area under the curve (73%-85%). We concluded that epigenetics could improve the accuracies of risk assessment.     

局部晚期食管鳞癌术前同期放化疗疗效及预后因素分析

目的评价局部晚期食管鳞癌术前同期放化疗治疗效果和影响预后的因素。方法回顾分析2007-2017年郑州大学附属肿瘤医院收治的148例经术前同期放化疗并手术治疗的局部晚期食管鳞癌患者资料,化疗采用氟尿嘧啶+顺铂或紫杉醇+顺铂方案,放疗剂量为36~40Gy,常规分割。Kaplan-Meier法计算生存率并Logrank检验及单因素分析,Cox模型多因素分析。结果全组1、3、5年总生存率分别为74%、51%、51%,无瘤生存率分别为60%、51%、45%;中位生存期为72.4个月,无瘤生存期为60.1个月。pCR与非pCR的1、3、5年总生存率分别为86%、70%、70%与70%、44%、43%(P=0.002),无瘤生存率分别为76%、71%、68%与53%、43%、37%(P=0.002)。pN(-)与pN(+)的1、3、5年总生存率分别为83%、56%、55%与50%、38%、38%(P=0.004),无瘤生存率分别为66%、56%、51%与43%、38%、31%(P=0.006)。多因素分析显示是否pCR和pN状态是影响总生存和无瘤生存的因素(P=0.012、0.011和P=0.025、0.033)。结论术前同期放化疗治疗局部晚期食管鳞癌疗效显著,是否pCR和pN状态是预后影响因素。     

侵犯上呼吸消化道的高分化甲状腺癌的治疗

目的：探讨侵犯上呼吸消化道的高分化甲状腺癌的治疗方式。方法：回顾性分析62例侵犯上呼吸消化道的高分化甲状腺癌的治疗方法。全组均行手术治疗,术式以肿瘤削除术为主,17例患者术后行放射性碘治疗,3例行术后放疗。全部病例随访2～15年。结果：肿瘤局限性侵犯患者,手术削除干净无残留者5年局部控制率达100．0％(17／17);肿瘤广泛侵犯突入腔内而行扩大切除者为87．5％(7／8);局限性侵犯、手术削除不干净有残留者为55．6％(5／9)。姑息性切除疗效最差。17例少量肿瘤残留者术后行放射性碘治疗,其5年局部控制率与未作此治疗者,差异有显著性。结论：对于侵犯上呼吸消化道的高分化甲状腺癌,应根据具体情况选择合适的术式;对有少量肿瘤残留者术后应辅以同位素治疗,病程较晚期者宜行术后放疗。     

S19-mRNA expression in squamous cell carcinomas of the upper aerodigestive tract

BACKGROUND: The differential display method showed altered expression of ribosomal protein S19 gene in human head and neck squamous cell carcinoma (HNSCC) cell lines. MATERIALS AND METHODS: To verify these results, RT-PCR analysis was carried out in 18 HNSCC and 17 benign epithelial cell lines as well as 30 HNSCC and 8 reference tissue samples. In the HNSCC cells S19 mRNA expression was significantly reduced as compared to benign epithelial cells. RESULTS: Change of the S19 gene expression in surgical samples was detectable but not significant although the histopathological grading of the HNSCC biopsies correlated significantly with the S19 mRNA expression levels. The expression of ribosomal protein S6 and S14 genes were additionally analyzed using the same methods. CONCLUSION: High correlation was found between the expression of S6/S14 and S19 suggesting that changes in S19 gene expression might be the result of loss of ribosomes in HNSCC cells.     

Melanosis and squamous cell neoplasms of the upper aerodigestive tract in Japanese alcoholic men

Melanosis is frequently observed in the upper aerodigestive tract of Japanese alcoholic men, and the prevalences of squamous cell dysplasia and SCC in the upper aerodigestive tract of Japanese alcoholic men are high. This study evaluated associations between melanosis and both neoplasms of the upper aerodigestive tract and factors contributing to the development of melanosis in Japanese alcoholic men. Endoscopic screening of 643 Japanese alcoholic men (aged 50-79 years) was combined with oropharyngolaryngeal inspection and esophageal iodine staining, and ALDH2 genotyping was carried out in 425 of them. Melanosis was frequently (20.8%) observed in the upper aerodigestive tract. The palate was the most common site of melanosis (11.2%), followed by the pharynx (9.5%), and by the esophagus (7.0%). The incidence of melanosis was higher in those with esophageal dysplasia (31/126, 24.6%), esophageal SCC (19/42, 45.2%), and oropharyngolaryngeal SCC (8/14, 54.1%) than in cancer- and dysplasia-free controls (69/437, 15.8%). The presence of melanosis was associated with a higher risk of esophageal dysplasia, esophageal SCC, and oropharyngolaryngeal SCC (OR 1.69, 4.03, and 6.61, respectively). Multivariate analysis showed that older age, heavier smoking, and heterozygosity for inactive ALDH2 were positively associated with the presence of melanosis. The presence of melanosis indicates a high risk for neoplasms in the upper aerodigestive tract of Japanese alcoholic men. Melanosis and neoplasms have the same causes, including older age, heavy smoking, and high acetaldehyde exposure.     

Squamous cell carcinoma of the upper aerodigestive tract in nonusers of tobacco

Nine hundred forty-five patients with squamous cell carcinoma of the upper aerodigestive tract (SCC-UADT) were treated at three University of Louisville-affiliated hospitals from 1970 through 1979. Retrospective analysis disclosed that 33 patients (3.4%) never used tobacco. This group offers interesting contrasts to the more prevalent tobacco-related epidermoid cancers. Cancers in nonusers of tobacco (mean age, 68 years) occurred approximately 10 years later than most epidermoid UADT cancers. Women predominated with a ratio of 2.7 to 1. Fifteen of 16 patients (94%) older than 70 years were women. Twenty-four of 33 primary lesions (72%) were in the oral cavity and two thirds of these were staged 0, I, and II (American Joint Commission [AJC]). Of the patients younger than 70 years of age, 42% were men, 42% had non-oral primaries, and most (74%) had advanced disease in AJC Stages III and IV. Second squamous cell primaries of the UADT developed in 6 of the 33 patients (18%) with an average of 48 disease-free months. Five of six were oral lesions in patients with original oral primaries. Of the 16 patients older than 70 years with small, localized oral cancers, conservative surgery failed in 9 (56%). Although 4 were salvaged by re-excision or radiation, 5 of these 16 patients in AJC Stage 0, I, and II died of this cancer (32%). The tendency for conservative initial surgical treatment in older patients is believed to be responsible for the higher than expected rate of treatment failure. An aggressive approach is recommended and further supported by the complete absence of surgical mortality in this group of patients.     

Occupation and risk of upper aerodigestive tract cancer: the ARCAGE study

We investigated the association between occupational history and upper aerodigestive tract (UADT) cancer risk in the ARCAGE European case-control study. The study included 1,851 patients with incident cancer of the oral cavity, oropharynx, hypopharynx, larynx or esophagus and 1,949 controls. We estimated odds ratios (OR) and 95% confidence intervals (CI) for ever employment in 283 occupations and 172 industries, adjusting for smoking and alcohol. Men (1,457 cases) and women (394 cases) were analyzed separately and we incorporated a semi-Bayes adjustment approach for multiple comparisons. Among men, we found increased risks for occupational categories previously reported to be associated with at least one type of UADT cancer, including painters (OR = 1.74, 95% CI: 1.01-3.00), bricklayers (1.58, 1.05-2.37), workers employed in the erection of roofs and frames (2.62, 1.08-6.36), reinforced concreters (3.46, 1.11-10.8), dockers (2.91, 1.05-8.05) and workers employed in the construction of roads (3.03, 1.23-7.46), general construction of buildings (1.44, 1.12-1.85) and cargo handling (2.60, 1.17-5.75). With the exception of the first three categories, risks both increased when restricting to long duration of employment and remained elevated after semi-Bayes adjustment. Increased risks were also found for loggers (3.56, 1.20-10.5) and cattle and dairy farming (3.60, 1.15-11.2). Among women, there was no clear evidence of increased risks of UADT cancer in association with occupations or industrial activities. This study provides evidence of an association between some occupational categories and UADT cancer risk among men. The most consistent findings, also supported by previous studies, were obtained for specific workers employed in the construction industry.     

The role of radiation therapy in squamous cell carcinoma of the upper aerodigestive tract with positive surgical margins

One hundred four patients with squamous cell carcinoma of the upper aerodigestive tract and with histologically positive surgical margins were evaluated for this historically controlled study to determine the efficacy of postoperative radiation therapy. Positive margins were defined as the presence of one or more of the following: carcinoma in situ, tumor within 0.5 cm from the surgical margins, microscopic disease, or dysplasia. Patients received either surgery alone (44 cases) or surgery plus postoperative radiation therapy (60 cases) and were followed for a minimum of 2 years. Treatment strategies, stage by stage, were similar for all patients. Surgery varied from simple excision in T1 to composite resection and/or laryngopharyngectomy with radical neck dissection in advanced cases. Radiation therapy was given postoperatively with doses ranging from 4,500 to 7,500 cGy. The overall 2-year survival rate with no evidence of disease (NED) was consistently higher in the surgery plus radiation therapy group. Furthermore, when the subgroup of patients who had dysplasia at the surgical margins was excluded from the analysis, the 2-year NED survival rate difference became statistically significant (p = 0.05). This outcome favored combined therapy (36 of 58 patients) over surgery alone (13 of 32 patients). This favorable result was obtained despite the high percentage of T3-T4 stages (79 vs. 21%) and clinically positive lymph nodes (83 vs. 17%) in patients who had received postoperative radiation therapy. The significance of dysplasia at the surgical margins and the impact of radiation therapy on the tumor and nodal control in this group of patients needs further clarification.     

食管鳞癌术后放疗研究进展

手术是局限期食管癌的重要治疗手段,但单纯手术切除的 5 年生存率仅 20%~25%。早期研究显示术后放疗降低区域复发率,但并不能提高生存率。近期大部分研究显示Ⅲ期或淋巴结阳性患者能从术后放疗中生存获益,且pT_2-3N₀M₀期患者术后放疗可能获益。放疗靶区范围推荐以双侧锁骨上区、上纵隔、隆突下以及瘤床为主,大部分研究推荐下段病变应包括上腹部区域淋巴结。对局部晚期患者术后放疗联合化疗可能带来更大获益。关于食管鳞癌术后放疗意义、靶区设计及联合化疗等问题需个体化考量,需更多的临床证据。     

Risk of metachronous squamous cell carcinoma in the upper aerodigestive tract of Japanese alcoholic men with esophageal squamous cell carcinoma: a long-term endoscopic follow-up study

East Asian case–control studies have shown a strong relationship between alcohol consumption combined with inactive heterozygous aldehyde dehydrogenase-2 ( ALDH2 * 1/ * 2 ) and the development of squamous cell carcinoma (SCC), especially multiple SCC, of the upper aerodigestive tract (UADT). This study aimed to identify determinants of the development of metachronous SCC in the UADT in alcoholics with esophageal SCC. Follow-up endoscopic examinations were carried out 4–160 months (median, 41 months) after initial diagnosis in 110 Japanese alcoholic men with esophageal SCC diagnosed by screening using endoscopy combined with oropharyngolaryngeal inspection and esophageal iodine staining. ALDH2 * 1/ * 2 was significantly associated with the presence of multiple primary intraesophageal SCC at the time of initial diagnosis. Metachronous primary SCC of the esophagus was diagnosed in 29 of the 81 patients whose initial esophageal SCC was treated by endoscopic mucosal resection alone, and metachronous primary SCC of the oropharyngolarynx was diagnosed in 23 of the 99 patients without synchronous primary SCC of the oropharyngolarynx at the time of initial diagnosis. The risks of metachronous esophageal SCC and oropharyngolaryngeal SCC were significantly higher in ALDH2 * 1/ * 2 heterozygotes than in ALDH2 * 1/ * 1 homozygotes (age-adjusted and alcohol-adjusted hazard ratio = 3.38 [95% confidence interval: 1.45–7.85] and 4.27 [1.42–12.89], respectively), and in patients with multiple intraesophageal SCC at the time of initial diagnosis than in patients with a solitary intraesophageal SCC (3.09 [1.41–6.78] and 3.25 [1.41–7.47], respectively). ALDH2 * 1/ * 2 and multiple synchronous intraesophageal SCC were found to be predictors of metachronous SCC in the UADT in this population. ( Cancer Sci 2008; 99: 1164–1171)     

Basaloid squamous carcinoma of the upper aerodigestive tract. Clinicopathologic and DNA flow cytometric analysis

This report adds nine basaloid squamous carcinomas (BSC) of the upper aerodigestive tract to the 11 already recorded in the literature. It includes the first flow cytometric analysis of their DNA content and compares the clinical behavior of BSC with conventional squamous cell carcinoma (SCC). An uncommon variant of squamous carcinoma, BSC manifests a predilection for the hypopharynx and base of tongue of men in the sixth decade of life. Histologically, the carcinoma is characterized by a basaloid pattern often in an intimate association with focal squamous differentiation, comedonecrosis, and stromal hyalinization. It is an aggressive neoplasm: seven of the nine patients had metastases to cervical lymph nodes at time of initial surgery and three of the five deaths occurred within 24 months after primary surgery followed by radiotherapy. Its aggressiveness notwithstanding, the biologic course of BSC is similar to that of conventional SCC when clinical stage, site, and treatment are matched. Patients with aneuploid BSC had a better mean survival time (39.5 months) than those with diploid carcinomas (16.3 months). Surgery followed by radiotherapy appears to be the treatment of choice. Because of a high incidence of distant metastases, adjuvant chemotherapy may be warranted.