Department of Hepatobiliary & Pancreatovascular Surgery, Xiamen Humanity Hospital, Fujian Medical University, Xiamen, China.
Department of Surgery, First affiliated Hospital of Xiamen University, Xiamen, China.
ANZ J Surg. 2021 Mar;91(3):E91-E97. doi: 10.1111/ans.16452. Epub 2020 Nov 24.
Pure squamous cell carcinoma (SCC) of the gallbladder is rare and often confused with the adenosquamous carcinoma (ASC) subtype in previous studies. The present study was attempted to differentiate SCC from ASC by resolving their characteristics and prognosis.
The Surveillance, Epidemiology, and End Results database was queried for SCC and ASC of gallbladder cases from 1988 to 2015. Patients' clinicopathological characteristics and survival were analysed between the groups.
Of the 709 patients with primary gallbladder cancer included in this study, 249 (35.1%) had pure SCC and the remaining 460 (64.9%) had ASC. It was found that pure SCC was associated with a larger median tumour size (58.0 versus 41.0 mm, P < 0.001), while ASC presented with a worse histological grade (47.4% versus 37.8% for grades III-IV, P = 0.019) and more lymph node invasion (27.4% versus 18.9%, P = 0.041). The 3-year overall survival and disease-specific survival rates in pure SCC were lower than those in ASC (7.5% versus 11.5% for overall survival, P < 0.001; 6.2% versus 10.9% for disease-specific survival, P < 0.001). Multivariate analysis showed that early Surveillance, Epidemiology, and End Results historic stage, treatment with surgery and chemotherapy were significant favourable prognostic factors for pure SCC, while tumour size, late study period, treatment with surgery and radiotherapy were significant predictors for ASC.
There were significant differences in the clinicopathological characteristics and survival prognosis between pure SCC and ASC. Surgery combined with chemotherapy is the preferred treatment option for pure SCC.
胆囊单纯鳞癌(SCC)较为罕见,既往研究中常与腺鳞癌(ASC)亚型相混淆。本研究旨在通过明确 SCC 和 ASC 的特征和预后来对二者进行区分。
本研究检索了 1988 年至 2015 年期间的美国监测、流行病学和最终结果数据库中胆囊 SCC 和 ASC 病例。对两组患者的临床病理特征和生存情况进行分析。
本研究纳入了 709 例原发性胆囊癌患者,其中 249 例(35.1%)为单纯 SCC,其余 460 例(64.9%)为 ASC。结果发现,单纯 SCC 的肿瘤中位直径较大(58.0 毫米 vs. 41.0 毫米,P<0.001),而 ASC 的组织学分级较差(III-IV 级为 47.4% vs. 37.8%,P=0.019),且淋巴结侵犯更多(27.4% vs. 18.9%,P=0.041)。单纯 SCC 的 3 年总生存率和疾病特异性生存率均低于 ASC(总生存率为 7.5% vs. 11.5%,P<0.001;疾病特异性生存率为 6.2% vs. 10.9%,P<0.001)。多变量分析显示,早期 Surveillance、Epidemiology、End Results 分期、手术联合化疗是单纯 SCC 的显著有利预后因素,而肿瘤大小、研究后期、手术联合放疗是 ASC 的显著预测因素。
单纯 SCC 和 ASC 在临床病理特征和生存预后方面存在显著差异。手术联合化疗是单纯 SCC 的首选治疗方案。