Gallbladder sarcomatoid carcinoma: Seven case reports

BACKGROUND: Gallbladder sarcomatoid carcinoma is a rare and aggressive tumor, and little is known about its clinical behavior, prognosis, and optimal treatment. CASE SUMMARY: From 1997 to 2017, we collected seven cases of gallbladder sarcomatoid carcinoma at our institution. The median patient age was 68.5 years. Six (85.7%) patients were female. Overall, 85.7% (6/7) of the tumors had a maximal diameter greater than 7 cm. Late TNM stage was associated with a significantly poor prognosis. All patients with advanced-stage (III/IV) disease died from metastases or disease progression shortly after surgery. One patient with stage IIIB disease who received adjuvant chemoradiotherapy (gemcitabine and capecitabine) achieved a progression-free survival (PFS) of 12 mo and overall survival of 15 mo, which might be the longest PFS reported among patients who ultimately experienced recurrence or metastasis. CONCLUSION: Sarcomatoid carcinoma is a unique and aggressive gallbladder malignancy. Surgery is suggested as the first and only recognized treatment. There is a significant difference in prognosis between patients with early-stage and advanced-stage disease. Postoperative adjuvant therapy may bring survival benefits for locally advanced patients. Gemcitabine combined with fluorouracil and radiotherapy could be a potential strategy.