Journal of Radiation and Cancer Research (Jan 2024)
Squamous cell carcinoma of gallbladder: A systematic review
Abstract
Background: Pure squamous cell carcinoma (SCC) of gallbladder (GB) is a rare malignancy with a distinct clinicopathological spectrum compared to its adenocarcinoma variant. Owing to the scarcity of cases, a detailed course of it remains unknown. Search Methodology: A comprehensive search of the PubMed and Google Scholar was done to find all articles pertaining to pure SCC of GB. Individual patient data analysis and meta-analysis of 94 patients, data of whom gathered from 72 selected articles, were done to understand demography, patterns of care, prognostic variables, and survival outcome. Results: Female propensity was found with a median age of 64 years for the entire cohort. Cholelithiasis was frequently found (80.7%). Symptomatology was nonspecific, patients often presented with features of acute cholecystitis. In many instances, tumor was not found on imaging too, instead when simple cholecystectomy was attempted for cholelithiasis, cancer was eventually diagnosed per or postoperatively. No specific tumor marker was found. Tumors were usually bulky (average size = 6.58 cm) with extensive loco-regional spread and significant adjacent organ infiltration (advanced T and N stage), upfront metastases were unusual though (13.8%). The median survival of the presented cohort was 7 months (follow up period ranged from 1 to 120 months). The median disease-free survival was 6 months and an estimated 1, 3 and 5 years survival were 41.8%, 14.5%, and 11%, respectively. Surprisingly, 3 patients lived for 10 years and beyond, among them 2 had an early stage disease but one had T4 disease yet survived with radical surgery alone. Kaplan–Meier univariate survival analysis revealed that radical cholecystectomy (involving resection of GB, liver bed, involved organ and loco regional lymph nodes) with R0 margin and size of tumor ≤6.58 cm were associated with better survival. Conclusion: Our study suggests that radical cholecystectomy with R0 margin is crucial for favourable outcome. However, despite that, the outcome stays dismal. Focus on adjuvant therapies including chemotherapy and radiotherapy is the need of the hour.
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