根治性手术后胆囊腺鳞癌与单纯胆囊腺癌患者的临床病理特征及长期生存比较：中国单中心经验及荟萃分析
Comparison of clinicopathological characteristics and long-term survival between patients with gallbladder adenosquamous carcinoma and pure gallbladder adenocarcinoma after curative-intent surgery: a single-center experience in China and a meta-analysis.
作者信息
Lv Tian-Run, Liu Fei, Liang Zuo-Yu, Zou Rui-Qi, Ma Wen-Jie, Hu Hai-Jie, Li Fu-Yu
机构信息
Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
出版信息
Front Oncol. 2023 May 2;13:1116275. doi: 10.3389/fonc.2023.1116275. eCollection 2023.
OBJECTIVE
The aim of the study was to evaluate the similarities and differences between gallbladder adenosquamous carcinoma (GBASC) and pure gallbladder adenocarcinoma (GBAC).
METHODS
Patients with GBASC and GBAC from 2010 to 2020 were analyzed in terms of clinicopathological features and long-term survival. Moreover, a meta-analysis was also performed for further validation.
RESULTS
A total of 304 patients with resected GBC were identified, including 34 patients with GBASC and 270 patients with GBAC. Patients with GBASC had a significantly higher preoperative CA199 level (P <0.0001), a significantly higher incidence of liver invasion (P <0.0001), a relatively larger tumor size (P = 0.060), and a significantly higher proportion of patients with T3-4 (P <0.0001) or III-IV disease (P = 0.003). A comparable R0 rate was obtained between two groups (P = 0.328). A significantly worse overall survival (OS) (P = 0.0002) or disease-free survival (DFS) (P = 0.0002) was observed in the GBASC. After propensity score matching, comparable OS (P = 0.9093) and DFS (P = 0.1494) were obtained. Clear margin (P = 0.001), node metastasis (P <0.0001), T stage (P <0.0001), and postoperative adjuvant chemoradiotherapy (P <0.0001) were independent prognostic factors for OS for the entire cohort. Adjuvant chemoradiotherapy had a survival benefit for patients with GBAC, while the survival benefit was still being validated in patients with GBASC. With our cohort incorporated, a total of seven studies involving 1,434 patients with GBASC/squamous carcinoma (SC) were identified. GBASC/SC shared a worse prognosis (P <0.00001) and more aggressive tumor biological features than GBAC.
CONCLUSION
GBASC/SC shared more aggressive tumor biological features and a much worse prognosis than those with pure GBAC.
目的
本研究旨在评估胆囊腺鳞癌（GBASC）与单纯胆囊腺癌（GBAC）之间的异同。
方法
对2010年至2020年期间患有GBASC和GBAC的患者进行临床病理特征和长期生存分析。此外，还进行了荟萃分析以进一步验证。
结果
共鉴定出304例接受胆囊癌切除术的患者，其中包括34例GBASC患者和270例GBAC患者。GBASC患者术前CA199水平显著更高（P<0.0001），肝侵犯发生率显著更高（P<0.0001），肿瘤尺寸相对更大（P=0.060），T3-4期（P<0.0001）或III-IV期疾病（P=0.003）患者的比例显著更高。两组间R0切除率相当（P=0.328）。GBASC患者的总生存期（OS）（P=0.0002）或无病生存期（DFS）（P=0.0002）显著更差。倾向评分匹配后，OS（P=0.9093）和DFS（P=0.1494）相当。切缘阴性（P=0.001）、淋巴结转移（P<0.0001）、T分期（P<0.0001）和术后辅助放化疗（P<0.0001）是整个队列OS的独立预后因素。辅助放化疗对GBAC患者有生存获益，而对GBASC患者的生存获益仍在验证中。纳入我们的队列后，共鉴定出7项涉及1434例GBASC/鳞癌（SC）患者的研究。GBASC/SC与GBAC相比，预后更差（P<0.00001），肿瘤生物学特征更具侵袭性。
结论
与单纯GBAC相比，GBASC/SC具有更具侵袭性的肿瘤生物学特征和更差的预后。
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