Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
J Gastrointest Surg. 2021 Jul;25(7):1815-1827. doi: 10.1007/s11605-020-04729-w. Epub 2020 Jul 23.
A paucity of data exists regarding adenosquamous carcinoma of the gallbladder, a histology comprising under 10% of gallbladder cancer diagnoses. The aim of this study is to characterize the clinicopathological features of these tumors utilizing a population-based dataset compared with gallbladder adenocarcinoma.
We identified patients with gallbladder adenosquamous and adenocarcinoma from the National Cancer Database from 2004 to 2015. Patient demographics, tumor characteristics, treatment regimens, and overall survival were analyzed between the groups.
We identified 13,158 patients: 12,455 (95%) with a diagnosis of gallbladder adenocarcinoma and 703 (5%) with adenosquamous carcinoma. Adenosquamous tumors were larger, poorly differentiated, and presented with Stage III/IV disease (75% vs 69%, p < 0.001). Overall 1-, 3-, and 5-year survival for adenosquamous and adenocarcinoma were 24%, 11%, and 9% vs 37%, 16%, and 11%, respectively (p < 0.001). Following surgical resection, adenosquamous carcinoma had more positive margins (31% vs 25%, p < 0.001), and median overall survival was 10.3 months vs 20.5 months for adenocarcinoma (p < 0.001). Overall survival at 1-, 3-, and 5-years for surgically resected adenosquamous and adenocarcinoma were 43%, 23%, and 18% versus 63%, 35%, and 25%, respectively (p < 0.001). In resected adenosquamous carcinoma, positive lymph nodes and margins were associated with worse survival, while adjuvant chemoradiation (HR 0.457, 95% CI 0.31-0.69, p < 0.001) was associated with improved survival.
Adenosquamous gallbladder cancer presented with larger tumors at advanced clinical stages when compared with adenocarcinoma. Overall survival was worse for adenosquamous tumors both overall, and following curative intent resection. Adjuvant chemoradiation was associated with improved survival in adenosquamous tumors.
胆囊腺鳞癌的相关数据很少，这种组织学类型占胆囊癌诊断的不到 10%。本研究的目的是利用基于人群的数据集，与胆囊腺癌相比，对这些肿瘤的临床病理特征进行描述。
我们从 2004 年至 2015 年的国家癌症数据库中确定了患有胆囊腺鳞癌和腺癌的患者。对两组患者的人口统计学特征、肿瘤特征、治疗方案和总生存情况进行了分析。
我们共确定了 13158 名患者：12455 名（95%）诊断为胆囊腺癌，703 名（5%）为腺鳞癌。腺鳞癌肿瘤更大，分化程度更低，且处于 III/IV 期（75%比 69%，p<0.001）。腺鳞癌和腺癌的 1 年、3 年和 5 年总生存率分别为 24%、11%和 9%和 37%、16%和 11%（p<0.001）。手术后，腺鳞癌的切缘阳性率更高（31%比 25%，p<0.001），腺癌的中位总生存时间为 10.3 个月，而腺鳞癌为 20.5 个月（p<0.001）。手术切除的腺鳞癌和腺癌 1 年、3 年和 5 年总生存率分别为 43%、23%和 18%和 63%、35%和 25%（p<0.001）。在可切除的腺鳞癌中，阳性淋巴结和切缘与生存率降低相关，而辅助放化疗（HR 0.457，95%CI 0.31-0.69，p<0.001）与生存率提高相关。
与腺癌相比，腺鳞癌的胆囊癌表现为更大的肿瘤，处于更晚期的临床阶段。腺鳞癌的总生存率和根治性切除后的总生存率均较差。辅助放化疗与腺鳞癌的生存改善相关。
