Analysis on clinicopathological characteristics and prognostic factors of adenoma-associated gallbladder carcinoma

Gallbladder adenomas are relatively rare in clinical practice, which have tendency of malignant transformation. There might be differences in biological characteristics and prognosis between gallbladder carcinoma (GBC) associated and not associated adenoma. Few related literatures have been reported. All consecutive patients who underwent curative-intent resection for GBC at our institution between 2009 and 2021 were retrospectively analyzed. Clinicopathological characteristics and overall survival (OS) were compared between the two groups, including a propensity score-matched analysis. The clinicopathologic data and OS of 359 GBC patients were retrospectively analyzed, including 88 adenoma-associated GBC (AAGBC) and 271 conventional GBC cases. The clinicopathological characteristics and prognosis of AAGBC are significantly different from those of conventional GBC. AAGBC showed relatively earlier tumor stage, lower incidence of liver invasion and lymph node metastasis, better tumor differentiation degree, lower tumor marker levels and lower gallstone correlation (all P < 0.05). Meanwhile, the OS of AAGBC patients were significantly better (40.0 vs. 26.0 months, P < 0.001). Survival differences persisted even after propensity score matching (40.0 vs. 34.0 months, P = 0.038). Differences on tumor marker levels and tumor differentiation degree also remains significantly. Further multivariate analysis determined that tumor stage, tumor differentiation degree, vascular invasion and surgical margin were independent prognostic factors of AAGBC patients. No significant difference was found in clinicopathological characteristics and survival among AAGBC from three different adenoma sub-types. AAGBC are often found in the relatively early stage, and exhibit milder biological behaviors and better prognosis. However, it is still far from optimistic. Therefore, patients with gallbladder adenoma should be regularly followed up and those of high malignant transformation risk should be promptly performed laparoscopic cholecystectomy.