Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2023; 15(8): 1436-1450
Published online Aug 15, 2023. doi: 10.4251/wjgo.v15.i8.1436
Comparison of clinicopathological characteristics and survival outcomes between gallbladder mucinous adenocarcinoma and gallbladder adenocarcinoma: A propensity score-matched study
Wen-Wei Yang, Yu-Ting Fang, Ya-Ru Niu, Yong-Kun Sun
Wen-Wei Yang, Yu-Ting Fang, Ya-Ru Niu, Yong-Kun Sun, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Yong-Kun Sun, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Langfang 065001, Hebei Province, China
Author contributions: Yang WW contributed to the study design, data collection and analysis, and manuscript composition; Fang YT and Niu YR helped to perform and check the statistical analysis; Sun YK contributed to proofreading and final approval of the article; All authors read and approved the final version.
Supported by The National Key Research and Development Program of China, No. 2021YFF1201300.
Institutional review board statement: As the SEER database is publicly available and de-identified, therefore, the ethical approval was exempted by the ethics committee of our hospital.
Informed consent statement: The SEER database is a public-use database. After submitting a request to the SEER database project and obtaining permission, data freely downloaded from the SEER database did not require patients’ informed consent or institutional approval.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at email address. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Kun Sun, MD, Professor, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. hsunyk@cicams.ac.cn
Received: March 25, 2023
Peer-review started: March 25, 2023
First decision: May 22, 2023
Revised: June 3, 2023
Accepted: June 19, 2023
Article in press: June 19, 2023
Published online: August 15, 2023
Processing time: 138 Days and 4.6 Hours
Abstract
BACKGROUND

Gallbladder mucinous adenocarcinoma (GBMAC) is a rare subtype of gallbladder adenocarcinoma (GBAC), with limited knowledge of its survival outcomes from small case series and single-center retrospective analysis.

AIM

To compare the clinicopathological characteristics of GBMAC with typical GBAC and its prognostic factors to gain insights into this field.

METHODS

This study was conducted using data from the Surveillance, Epidemiology, and End Results database, including cases of GBMAC and typical GBAC diagnosed from 2010 to 2017. The Pearson chi-square test or Fisher exact test was used to examine the differences in clinicopathological features between these two cohorts. In addition, propensity score matching (PSM) analysis was performed to balance the selection biases. Univariate and multivariate Cox hazards regression analyses were performed to determine independent prognostic factors for cancer-specific survival (CSS) and overall survival (OS). The Kaplan–Meier curves and log-rank tests were used to assess the OS and CSS of GBMAC and typical GBAC patients.

RESULTS

The clinicopathological and demographic characteristics of GBMAC were different from typical GBAC. They included a larger proportion of patients with unmarried status, advanced American Joint Committee on Cancer (AJCC) stage, higher T stage, higher N1 stage rate and lower N0 and N2 stage rates (P < 0.05). Multivariate analyses demonstrated that surgery [OS: Hazard ratio (HR) = 2.27, P = 0.0037; CSS: HR = 2.05, P = 0.0151], chemotherapy (OS: HR = 6.41, P < 0.001; CSS: HR = 5.24, P < 0.001) and advanced AJCC stage (OS: Stage IV: HR = 28.99, P = 0.0046; CSS: Stage III: HR = 12.31, P = 0.015; stage IV: HR = 32.69, P = 0.0015) were independent prognostic indicators for OS and CSS of GBMAC patients. Furthermore, after PSM analysis, there was no significant difference between GBMAC and matched typical GBAC patients regarding OS (P = 0.82) and CSS (P = 0.69).

CONCLUSION

The biological behaviors of GBMAC are aggressive and significantly different from that of typical GBAC. However, they show similar survival prognoses. Surgery, chemotherapy, and lower AJCC stage were associated with better survival outcomes. Further research is needed in the future to verify these results.

Keywords: Gallbladder mucinous adenocarcinoma; Gallbladder adenocarcinoma; Surveillance, Epidemiology, and End Results; Prognosis; Risk factors

Core Tip: Gallbladder mucinous adenocarcinoma (GBMAC) is a rare subtype of gallbladder adenocarcinoma (GBAC), with limited knowledge of its survival outcomes. Based on a large database, we compared the clinicopathological characteristics of GBMAC with typical GBAC and identified prognostic factors for GBMAC. The results showed that the biological behaviors of GBMAC are significantly different from typical GBAC, while survival outcomes for GBMAC patients were not worse than those for typical GBAC patients. Surgery, chemotherapy, and lower American Joint Committee on Cancer stage were associated with better survival outcomes.