Hepatoid Adenocarcinoma of Stomach: Emphasis on the Clinical Relationship with Alpha-Fetoprotein-Positive Gastric Cancer.

Er-Bao Chen,Hai-Ning Liu,Meng-Ling Liu,Ke Peng,Yi-Chou Wei,Tianshu Liu,Cheng Tang

doi:10.1155/2019/6710428

Abstract

Aims Both hepatoid adenocarcinoma of stomach (HAS) and alpha-fetoprotein-positive gastric cancer (AFPGC) are rare but aggressive subtypes of gastric cancer, but few studies focus on the clinicopathologic differences and prognostic factors between them because of their rarity and histologic overlap. And the significance of AFP level in HAS prognosis was not well studied. Methods 41 patients with AFPGC and 52 patients with HAS were included in this study. The clinicopathologic features were compared by Chi-square analysis. Prognostic factors for overall survival (OS) and disease-free survival (DFS) were analyzed with the Kaplan-Meier method. Results The patients with HAS were of a younger age compared with AFPGC, and nearly 60% of tumor located in the gastric antrum and the gastric fundus of cardia. The OS of AFPGC was shorter than that of HAS, due to a higher rate of metastasis. Furthermore, the survival analysis showed that HAS with high AFP expression (AFPHigh HAS) had a significantly poorer OS compared to HAS with low AFP expression (AFPLow HAS) (P=0.046). Conclusions Compared with AFPGC, the patients of HAS were of a younger age and had less rate of liver and other organ metastasis. The serum AFP level was a sensitive prognostic indicator for OS. Therefore, much attention should be paid to AFPHigh HAS in clinical practice.

Highlights

Alpha-fetoprotein (AFP), a kind of oncogenic glycoprotein, is originally found in the human fetus and is mainly synthesized and secreted by the fetal liver, yolk sac, and some gastrointestinal cells, which rapidly decreases after birth [1, 2]
In 1970, Bourreille’s group first described a case of gastric adenocarcinoma with liver metastasis, and its serum and pathological specimen were positive for AFP, which led to the term “AFP-positive gastric cancer (AFPGC)” [11]
We found that hepatoid adenocarcinoma of stomach (HAS) patients with high AFP expression had a worse overall survival compared to those with low AFP expression

Summary

Introduction

Alpha-fetoprotein (AFP), a kind of oncogenic glycoprotein, is originally found in the human fetus and is mainly synthesized and secreted by the fetal liver, yolk sac, and some gastrointestinal cells, which rapidly decreases after birth [1, 2]. In 1970, Bourreille’s group first described a case of gastric adenocarcinoma with liver metastasis, and its serum and pathological specimen were positive for AFP, which led to the term “AFP-positive gastric cancer (AFPGC)” [11]. APFGC has a higher incidence of venous invasion and liver metastasis compared with AFP negative gastric cancer [13, 14]. Some researchers observed that certain lesions mimicked HCC-like morphology under the light microscope, especially in these AFPGCs with high serum level of AFP. Hepatoid adenocarcinoma (HAC) is a malignant cancer manifesting outside of liver that presents morphological areas identical to that of HCC. Compared with other types of gastric cancer, hepatoid adenocarcinoma of stomach (HAS) progresses rapidly and metastasizes to lymph node or liver. We found that HAS patients with high AFP expression had a worse overall survival compared to those with low AFP expression

Materials and Methods

Results

Conclusions