Presenter: Yael Berger MD | Icahn School of Medicine at Mount Sinai Background: Gallbladder cancer accounts for 1.2% of total global cancer diagnoses, with an increasing incidence in the developed world. The literature on clinicopathologic characteristics and prognosis of biliary type adenocarcinoma and specifically of carcinoma arising from intracholecystic papillary-tubular neoplasms of the gallbladder is limited. This study describes a single institution experience in New York City. Methods: A retrospective review was performed of patients who underwent cholecystectomy for a malignant neoplasm of the gallbladder between 2007 and 2017. Demographic, clinicopathologic, and operative variables, and survival outcomes were analyzed. All available pathologic specimens were re-reviewed by a hepatobiliary pathologist. Results: A total of 145 patients were identified. The most common histological subtype was biliary-type adenocarcinoma, accounting for 93 (64%) cases. Compared to non-biliary adenocarcinoma, biliary-type adenocarcinomas were diagnosed at a lower AJCC pathologic stage (p = 0.045) [stage I- 18% versus 8% respectively, p = 0.2; stage II- 33% versus 19% respectively, p = 0.2; stage III- 42% versus 50% respectively, p = 0.5; stage IV- 7% versus 23% respectively, p = 0.023] and demonstrated a trend towards higher margin-negative (R0) resection rate (81% versus 62%, p = 0.06). Furthermore, median recurrence free survival was significantly longer for biliary-type adenocarcinoma when compared to other adenocarcinoma subtypes [38 months versus 16 months respectively, p = 0.014; median follow-up 36 months;]. Tumors arising from intracholecystic papillary-tubular neoplasms were found in 18 (12%) patients and were more commonly associated with biliary-type adenocarcinoma (14 patients). Compared to 29 cases of biliary-type adenocarcinoma that were not associated with intracholecystic papillary-tubular neoplasm, biliary-type adenocarcinoma associated with intracholecystic papillary-tubular neoplasm demonstrated lower pathologic stage (p = 0.006) [stage I- 57% versus 14% respectively, p = 0.009; stage II- 36% versus 28% respectively, p = 0.7; stage III- 7% versus 55% respectively, p = 0.003; stage IV- 0% versus 3% respectively, p = 1] and lower rates of liver invasion (0% versus 49%, p<0.001) and peri-neural invasion (14% versus 48%, p = 0.04). Overall 5-year survival rate was higher for patients with gallbladder neoplasm of any subtype associated with intracholecystic papillary-tubular neoplasms compared to those that were not associated with intracholecystic papillary-tubular neoplasms (54% versus 41%, p = 0.019; Median follow-up 23 months); this difference was also found to be significant when comparing between biliary-type adenocarcinoma alone (63% for tumors arising from intracholecystic papillary-tubular neoplasms versus 52% for tumors that did not, p = 0.005) [Figure]. Conclusion: This study demonstrates unique pathological and prognostic features of biliary-type adenocarcinoma and of carcinoma arising from intracholecystic papillary-tubular neoplasms. Histopathological variance may implicate prognosis and be used to better guide clinical decision making in treatment of these patients.

Background In the United States, mortality after a diagnosis of hepatocellular carcinoma (HCC) is higher in patients who are Black than in patients of other racial groups. The objective of this study was to clarify factors contributing to this disparity by analyzing liver and tumor characteristics in patients with HCC who have a history of hepatitis C virus (HCV) infection. Methods Records of patients with HCV and HCC at the authors' institution from 2003 to 2018 were retrospectively reviewed. Race and ethnicity were self-identified. Imaging, laboratory, and pathologic features were compared between Black and non-Black cohorts. Results Among 1195 individuals with HCC, 390 identified as Black. At the time of HCC diagnosis, Black patients had better liver function, as measured by Child-Pugh score, Model of End-Stage Liver Disease score, histology of nontumor tissue, and fibrosis-4 (FIB-4) score (all P < .05). FIB-4 scores were <3.25 in 31% of Black patients. In addition, Black patients had less early stage HCC (20.2% vs 32.3%; P < .05), larger tumors (median [interquartile range]: 3.5 cm [2.2-6.2 cm] vs 3.1 cm [2.1-5.1 cm]; P < .01), more multiple tumors (median, [interquartile range]: 1 tumor [1-3 tumors] vs 1 tumor [1-2 tumors]; P = .03), more poorly differentiated tumors (30.3% vs 20.5%; P < .05), and more microvascular invasion (67.2% vs 56.5%; P < .05). Conclusions Black patients with HCV exposure develop HCC at earlier stages of liver disease than members of other racial groups. Nearly one-third would not qualify for HCC screening using the common FIB-4 cirrhosis threshold. Practice guidelines that stress HCC surveillance for cirrhotic patients with HCV may need to be revised to be more inclusive for Black patients. In addition, tumors in Black patients carry worse prognostic features, and molecular studies are needed to characterize their biologic properties.