AUTHOR=Lv Tian-Run , Liu Fei , Liang Zuo-Yu , Zou Rui-Qi , Ma Wen-Jie , Hu Hai-Jie , Li Fu-Yu 

TITLE=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

JOURNAL=Frontiers in Oncology

VOLUME=Volume 13 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1116275

DOI=10.3389/fonc.2023.1116275

ISSN=2234-943X

ABSTRACT=Abstract
Objective: To evaluate the similarities and differences between gallbladder adeno-squamous carcinoma (GBASC) and pure gallbladder adenocarcinoma (GBAC). 
Methods: Patients with GBASC and GBAC from 2010 to 2020 were analyzed in terms of clinic-pathological features and long-term survival. Moreover, a meta-analysis was also performed for further validation. 
Results: 
Our experience: 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). 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 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 chemo-radiotherapy (P<0.0001) were independent prognostic factors on OS of the entire cohort. Adjuvant chemo-radiotherapy had survival benefit for patients with GBAC while the survival benefit was still for validation in patients with GBASC. 
Meta-analysis: With our cohort incorporated, a total of seven studies with 1434 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 much worse prognosis than those with pure GBAC.