Squamous Cell,Adenosquamous And Neuroendocrine Carcinoma Of The Gallbladder:Clinical Analysis With Adenocarcinoma

ObjectivesTo explore the clinicopathologic characteristics and surgical outcomes of squamous cell,adenosquamous,and neuroendocrine carcinoma of gallbladder.MethodsA retrospective analysis of selected 341 cases of proven gallbladder cancer from January 1st,2010 to December 31st,2017 enrolled in our hospital was done,and divided the cases into 3 groups for comparison,including 23 with adenosquamous/squamous cell carcinoma(ASC-SCC),11 with neuroendocrine carcinoma(NEC),and 307 with adenocarcinoma(AC).The comparison was based on the pre-operative general condition,surgical treatment,pathological results,and post-operative survival time.ResultsIn pre-operative condition,only the liver function examination showed significance in which ASC-SCC group had the highest portion of elevated ALT,AST,ALP,and γ-GT.The 3 groups had no significance in surgical type.R0 resection could improve the overall prognosis(P=0.004),especially the NEC group.The median intra-operative bleeding of ASC-SCC group was 400 ml,which was larger than those of other groups.And the mean operation time of ASC-SCC was also the longest(290min),and the next was NEC(240min),and the shortest was AC(190min).The GTD of NEC was the largest(4.2cm),the next was ASC-SCC(4.0cm),and the smallest was AC(2.6cm).All cases of ASC-SCC and NEC were T3 and T4 diseases.But AC group had 1 case of T1 and 5 cases of T2.Both the tumor of ASC-SCC and AC focused on T3(69.6%and 88.6%respectively).However,lymph node metastasis and TNM staging showed no significance in 3 groups.The prognosis of ASC-SCC was the poorest with mean survival time of 7.1 months,while that of NEC was 15.5 months,and AC was 15.4 months(P=0.001).But the survival distribution,including 6 months’ and 1 to 5 years’survival rates,had no significance.ConclusionThe clinical manifestation of adenosquamous,squamous cell carcinoma and neuroendocrine carcinoma was similar to that of adenocarcinoma,but the former three had stronger aggressiveness.And the neuroendocrine had the largest tumor size,and was more prone to distant metastasis.Lymph node metastasis was an important prognostic factor.When stayed in N1 metastasis,ASC-SCC had the worst prognosis.Although R0 resection could improve the overall prognosis,it still could not bring ASC-SCC to the similar prognosis level of AC.And NEC could be closed to AC after R0 resection.The sensitive and specific tumor marker of gallbladder cancer was waiting to be discovered.