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ANALYSIS ON CLINICOPATHOLOGICAL CHARACTERISTICS AND PROGNOSTIC FACTORS OF GALLBLADDER CARCINOMA FROM ADENOMA
Rui-Qi Zou
*, Yu-Shi Dai, Fei Liu, FuYu Li
West China Hospital of Sichuan University, Chengdu, Sichuan, China
Background:
Gallbladder adenomas (GBA) are rare in clinical practice. It is generally believed that the most common and classic pathway of gallbladder carcinoma (GBC) is hyperplasia - carcinoma in situ – invasive carcinoma, while the malignant transformation of GBA is unusual. There might be differences in biological characteristics and prognostic factors between GBC from malignant transformation of adenoma and conventional GBC, while there are a few literatures reported.
Methods:
The clinicopathologic data and prognostic information of 359 GBC patients who underwent radical-intent surgery in our institution from January 2009 to December 2021 were retrospectively analyzed. including 88 cases of GBC from adenoma and 271 cases of conventional GBC.
Results:
1. The clinicopathological characteristics of GBCs from adenoma are significantly different from those of conventional GBCs. GBC from adenoma showed relatively earlier tumor stage, lower incidence of liver invasion and lymph node metastasis, well degree of tumor differentiation, lower levels of preoperative CA19-9, CA125 and CEA, lower gallstone correlation, more intraoperative blood loss and longer length of inpatient stay (Figure 1). Meanwhile, the overall survival (OS) of patients with GBC from adenoma was significantly better than that of conventional GBC patients (40.0 months vs 26.0 months, P<0.001; Figure 2D);
2. Survival differences between the two groups persisted after propensity score matching (PSM) (40.0 months vs 34.0 months, P=0.038; Figure 2E). Compared with conventional GBC of same stage, the preoperative levels of CA19-9 and CA125 were significantly lower in the GBC from adenoma group, and the degree of tumor differentiation was also significantly well;
3. The result of multivariate analysis showed that tumor stage (P=0.016), degree of tumor differentiation (P=0.025), vascular invasion (P=0.024) and surgical margin (P=0.042) were independent prognostic factors of patients with GBC from adenoma;
4. Among GBC from adenomas in different pathological types (including 41 papillary, 22 tubular and 25 papillary; Figure 2A, 2B, 2C)), no significant difference was found in clinicopathological characteristics and survival time.
Conclusion:
Compared with conventional GBC, patients with GBC from adenoma are more often found in the relatively early stage, and exhibit milder biological behaviors and higher postoperative survival rates, showing relatively good prognosis. But it is still not optimistic. The median OS is less than 3 years for patients with advanced malignant adenoma. Therefore, patients with gallbladder polyps found should be regularly followed up according to the recommendations of the guidelines, and those with risk factors for malignant transformation should be promptly performed laparoscopic cholecystectomy to avoid occurrence of GBC.
Comparison of clinicopathological characteristics between GBC from adenoma and conventional GBC.
Postoperative pathological examination of GBC from adenoma (Hematoxylin-eosin staining): A. GBC from papillary adenoma; B. GBC from tubular adenoma; C. GBC from tubular-papillary adenoma; Overall survival comparison between conventional GBC (not from adenoma) and GBC from adenoma: D. Before PSM; E. After PSM.
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