Investigating laryngeal basaloid squamous cell carcinoma prognosis.

To the Editor: I read with great interest the recent article by Fritsch and Lentsch, who investigated laryngeal basaloid squamous cell carcinoma (BSCC) prognosis using the populationbased cancer registries of the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. Although the study by Fritsch and Lentsch is inevitably characterized by a potential bias relating to the fact that the cases of BSCC were diagnosed and treated by different teams and in different ways, the numerosity of the cases considered is remarkable. These studies are important, particularly those comparing the prognosis for head and neck BSCC as opposed to conventional squamous cell carcinoma (SCC) in site-matched and stage-matched settings, because numerous—but not all—investigators currently believe that head and neck BSCC is a significantly more aggressive lesion and carries a worse prognosis than the more commonly encountered SCC. Confirmation of the greater aggressiveness of head and neck BSCC visa-vis conventional SCC could rationally justify a more aggressive approach to their locoregional treatment and possibly the use of adjuvant chemotherapy in head and neck BSCC. However, because the mistakes made (and reiterated) in citations eventually have a significant impact on the international medical literature, I have to point out that, in their reference number 22, Fritsch and Lentsch misquote the content of a study conducted by our group in this field. In the investigation concerned, the 9 BSCCs considered did not all arise in the larynx (but 5 in the larynx, 3 in the tongue, and 1 in the tonsil), whereas another study by our group analyzed the prognostic role of the apoptosis inhibitor protein survivin in 9 consecutive cases of laryngeal BSCC, and, in this latter series, the diseasespecific survival (DSS) was 55.6%. In speaking about the prognosis for BSCC of the head and neck, it is extremely important to be accurate about the site involved by the primary lesion. In fact, a more recent study by Fritsch and Lentsch concluded that the DSS of patients treated for laryngeal BSCC was significantly lower than for patients with conventional SCC on multivariate analysis, but patients with oropharyngeal BSCC had a higher DSS than those with oropharyngeal conventional SCC (reported data source: Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, September 2005; size of the populations considered: 1083 head and neck BSCCs, 66,929 conventional SCC).