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Rare Types Of Cancer

Mark P Anstadt, MD(*); Karen W Eldin, BA; Howard S Gordon, MD; Bhuvaneswari Krishnan, MD; Mark K Kuebeler, MS; Ernesto R Soltero, MD and Linda K Green, MD. Surgery, Baylor College of Medicine, Houston VA Medical Center, Houston, TX; Pathology, Baylor College of Medicine, Houston VA Medical Center, Houston, TX and Medicine, Houston VA Medical Center, Houston, TX.

PURPOSE: Basal cell (Basaloid) carcinoma (BCC) of the lung was initially described in 1992. It has been characterized by French investigators as a rare variant (5%) of non-small cell lung cancer (NSCCA) which is highly aggressive. The reported median survival for stage I and II BCC is 22 months. Despite resection of even early stage lesions, the reported 5-year survival rate is 0%. The purpose of this study was to determine the incidence and prognostic implications of BCC compared to other types of NSCCAs in a representative, United States population.

METHODS: All patients diagnosed with lung cancer at the Houston Veterans Affairs Medical Center between 1995-1999 (n=956) were reviewed. Pathologic specimens labeled as poorly differentiated carcinoma were identified and underwent further review including histologic re-examination. Cases were then accordingly classified into BCC and other NSCCA categories. Mortality, therapeutic interventions, and stage at presentation were compared between BCC and other NSCCAs. Data was analyzed by logistic regression and chi-squared tests using SAS statistical software.

RESULTS: The overall incidence of BCC was 127/956 (13.3%) and was equally distributed over the five year study period. The overall mortality associated with BCC was significantly lower than that of other NSCCAs (60.6% vs 81.2%; p [is less than] 0.0001). Although the relative frequency of early stage cancers (I-IIIa)was higher in BCC versus other NSCCAs (59.1% vs 25.8%, p [is less than] 0.0001), the odds ratio hr death when controlling for stage at presentation was 0.53; (95% CI 0.34-0.83, p=0.006). In those patients who expired, the mean survival time was significantly greater for BCC versus other NSCCAs (243 vs 183 days, p [is less than] 0.0001). Furthermore, the actual 5-year survival rate of patients (diagnosis in 1995) was 6/27 (22%).

CONCLUSION: In the present study, the incidence of the BCC variant was higher than that previously reported. Furthermore, the BCC variant of NSCCA tended to present at an earlier stage and has a relatively favorable affect on prognosis compared to other NSCCAs. The discrelpancies from prior reports may reflect differences in treatment protocols and/or geographic behavior of this unique histologic variant.

CLINICAL IMPLICATIONS: The BCC variant of NSCCA may be more common than previously believed. Additionally, the prognostic implications of Basaloid carcinoma may, in fact, be favorable when compared to other NSCCAs. Therefore, the treatment of BCC at this time should not differ from that of other NSCCAs. Further studies are needed to determine if BCC uniquely differs in its clinical behavior compared to other NSCCAs.

COPYRIGHT 2000 American College of Chest Physicians
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