Abstract
Alpha-fetoprotein (AFP)-producing adenocarcinoma from the gastrointestinal tract (APA-GI) is a rare type of highly malignant tumor with a poor prognosis. It may originate from any site along the GI tract with similar clinicopathological characteristics. As limited research had ever described the characteristics of APA-GI, the present article intends to systemically investigate the clinicopathological characteristics of APA-GI from a single center's retrospective study to deepen the understanding of the disease. A total of 177 patients pathologically diagnosed with APA-GI between 2010 and 2017 at the Second Affiliated Hospital of Zhejiang University, School of Medicine, were included. Also, clinical data of 419 gastric cancers and 609 colorectal cancers from The Cancer Genome Atlas database were also extracted. Clinical information of patients from Second Affiliated Hospital of Zhejiang University, School of Medicine, was collected, and a median follow-up of 14.5 months was performed to investigate clinical characteristics of APA-GI. For the pathological characteristics of APA-GI, hematoxylin–eosin sections were reviewed, and immunohistochemistry of AFP was performed. The results showed that the primary tumor could develop through the whole GI tract, including the esophagus (0.6%), stomach (83.1%), duodenum (1.1%), ileum (0.6%), appendix (0.6%), colon (5.1%), and rectum (7.9%). Hepatoid adenocarcinoma is the main pathological feature of APA-GI. AFP expression level in tumor tissue was not strictly associated with serum AFP or hepatoid differentiation. The prognosis of APA-GI was worse than that of common adenocarcinoma of the GI tract and liver metastasis, and high AFP levels suggest poor prognosis in patients with APA-GI. Therefore, the present study was the first research to systemically explore the clinicopathological characteristics of APA-GI. APA-GI occurs through the whole GI tract with a significantly worse prognosis than common adenocarcinoma of GI. APA-GI should be regarded as one kind of disease for its similar clinicopathological characteristics within patients.
Highlights
Alpha-fetoprotein (AFP) is a glycoprotein produced by the fetal liver, yolk sac, and fetal gastrointestinal cells
We found that AFP ≥ 200 ng/ml was an independent risk factor for the liver metastasis of AFP-producing adenocarcinoma (APA)-GI (Table 5)
We suggested APA-GI should be regarded as one kind of disease, and its diagnosis depends on both serum AFP level and pathology
Summary
Alpha-fetoprotein (AFP) is a glycoprotein produced by the fetal liver, yolk sac, and fetal gastrointestinal cells. APA is a rare type of highly malignant tumor with a fairly poor prognosis [3, 4] It can originate from a variety of organs and mainly occurs in the digestive tract. Patients pathologically diagnosed with APA-GI between 2010 and 2017 at the Second Affiliated Hospital of Zhejiang University, School of Medicine (SAHZU) were included in the study. APA-GI was defined as follows: [1] pathologically confirmed primary gastrointestinal adenocarcinoma and [2] serum AFP>20 ng/ml during the whole course. For patients from SAHZU, clinical characteristics were all collected from the hospital information system, which included age, sex, primary tumor location, tumor size, pathological type, differentiated level, tumor–node–metastasis (TNM) staging, metastasis status, operation method, operation time, post operation pathology, serum AFP level, and treatment strategy. Statistical and graphical analyses were performed with SPSS 23.0 and GraphPad Prism 7 software
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