Clinical Outcomes of Basaloid Squamous Cell Carcinoma ofthe Esophagus: A Retrospective Analysis of 142 Cases

Background: Basaloid squamous cell carcinoma of the esophagus (BSCCE) is a rare and distinctive tumorwith no standard treatment. This study aimed to explore treatment in relation to prognosis of the disease.
Methods: A total of 142 patients with BSCCE that underwent treatment in our hospital from March 1999 toJuly 2010 were retrospectively analyzed. All patients received surgery, 42 postoperative radiotherapy and 28patients chemotherapy.
Results: There were 26 patients included in stage I, 60 in stage II, 53 in stage III and 3in stage IV. The clinical symptoms and macroscopic performances of BSCCE did not differ from those of typicalesophageal squamous cell carcinoma. Among 118 patients receiving endoscopic biopsy, only 12 were diagnosedwith BSCCE. The median survival time (MST) of the entire group was 32 months, with 1-, 3- and 5-year overallsurvival (OS) of 81.4%, 46.8% and 31.0%, respectively. The 5-year OS of stage I and II patients was significantlylonger than that of stages III/IV, at 60.3%, 36.1% and 10.9%, respectively (p<0.001, p=0.001). The MST and5-year OS were 59.0 months and 47.4% in patients with tumors located in the lower thoracic esophagus, and27.0 months and 18.1% in those with lesions in the upper/middle esophagus (p=0.002). However, the survivalwas not significantly improved in patients undegoing adjunctive therapy. Multivariate analysis showed TNMstage and tumor location to be independent prognostic factors. Furthermore, distant metastasis was the mostfrequent failure pattern, with a median recurrence time of 10 months.
Conclusion: BSCCE is an aggressive diseasewith rapid progression and a propensity for distant metastasis. It is difficult to make a definitive diagnosis viapreoperative biopsy. Multidisciplinary therapy including radical esophagectomy with extended lymphadenectomyshould be recommended, while the effectiveness of radiochemotherapy requires further validation for BSCCE.