Lung carcinomas with a basaloid pattern: a study of 90 cases focusing on their poor prognosis

Abstract

Lung carcinoma with a basaloid pattern (BC) is classified as either a basaloid variant of squamous cell carcinoma (SCC) or as variant of large cell carcinoma (LCC) depending on the presence of a squamous component. In a previous study of 37 cases, the present authors showed that BC presented with a shorter median and overall survival.In order to confirm its clinical significance in a larger series, 90 BC, including 46 basaloid variants of LCC and 44 basaloid variants of SCC, were compared with 1,328 other nonsmall cell lung carcinoma (NSCLC) with regard to clinical features and survival.The survival of basaloid variants of LCC and SCC was comparable. Median and overall survival were significantly lower for BC than for NSCLC in stage I-II patients, with a median survival of 29 and 49 months, respectively, and 5-yr survival rates of 27 and 44% for BC and NSCLC. When disease-specific survival was considered, BC had a shorter survival than both NSCLC and SCC.Basaloid pattern confers a poor prognosis in nonsmall cell lung carcinoma, especially in stage I-II patients, suggesting that lung carcinoma with a basaloid pattern is not only a variant of squamous cell carcinoma or large cell carcinoma, but is a unique entity with a significantly poor prognosis.

Stage-specific embryonic antigen-4is expressed in basaloid lung cancer and associated with poor prognosis

“…Without stratification for SSEA-4, the relapse rate (42%) and 5-yr survival rate (62%) of the entire collective was similar to that reported for overall early-stage NSCLC or poorly differentiated SCC (PDSC) [1][2][3][4][5][6]. This is in contrast to the results of Brambilla and co-workers [1,5,6], who reported a significantly worse outcome of basaloid carcinomas as compared with other NSCLC or PDSC: While the latter displayed a 5-yr survival rate of 44% and 47-55% in stage I/II disease, respectively, the 5-yr survival rate of early-stage basaloid NSCLC was 10-27% [1,5,6]. Conversely, previous studies of KIM et al [2] and WANG et al [28] in two Asian collectives likewise demonstrated comparable relapse rates (33-55%) and 5-yr survival rate (50-57%) for…”

“…Basaloid lung cancer represents a rare variant of NSCLC and showed an unfavourable prognosis in a number of studies [1,5,6]. BRAMBILLA et al [5], who were the first to describe this variant, speculated as early as 1992 that basaloid NSCLC might derive from a pluri-or multipotent pulmonary stem cell.…”

“…In contrast to overall NSCLC, which has a 5-yr survival rate of, on average, 40-60% and a median survival time of ,50 months in stage I/II disease, analyses of two European collectives comprising 38 and 90 patients with basaloid NSCLC revealed a significantly lower 5-yr survival rate of 10-27% and a shorter median survival time of 20-29 months [1,[3][4][5][6]. The basal cell phenotype of these carcinomas and their co-occurrence with virtually all histological subtypes of NSCLC soon led to the assumption that this variant derives from a pluri-or multipotent pulmonary stem cell [1,5,7]. In recent years, several in vitro and in vivo studies indicated the presence of stem-like cells in NSCLC.…”

“…asaloid lung cancer is a rare variant of pulmonary squamous cell carcinoma (SCC) or large cell carcinoma and accounts for 4.8-6.3% of all nonsmall cell lung cancer (NSCLC) cases [1,2]. In contrast to overall NSCLC, which has a 5-yr survival rate of, on average, 40-60% and a median survival time of ,50 months in stage I/II disease, analyses of two European collectives comprising 38 and 90 patients with basaloid NSCLC revealed a significantly lower 5-yr survival rate of 10-27% and a shorter median survival time of 20-29 months [1,[3][4][5][6].…”

Lung Squamous Cell Carcinomas with Basaloid Histology Represent a Specific Molecular Entity

“…Basaloid carcinoma account for about 5% of non-small cell lung carcinomas (NSCLC) and were identified as a histopathologic entity with a dismal prognosis (9,10). Among NSCLC and lung squamous cell carcinomas, the basaloid carcinoma (pure type) and the squamous variant of basaloid carcinoma (mixed basaloid SCC; WHO 2004) show the poorest prognosis (11). In the absence of specific molecular characteristics, basaloid carcinomas, in their pure form, were presented as a subtype of large-cell carcinoma (WHO 2004), while they very likely present distinct biologic characteristics, whose definition would be helpful in diagnosis and in the design of targeted treatment.…”