Objective To study the clinicopathological characteristics and prognostic risk factors of alpha-fetoprotein-positive gastric cancer(AFPGC)and hepatoid adenocarcinoma of the stomach(HAS).Methods The study retrospectively analyzed the clinical data of patients who underwent gastric cancer surgery at Xijing Hospital from January 2015 to December 2020.A total of 60 patients undergoing AFPGC surgery and 39 patients undergoing HAS surgery were included in the analysis.Clinical data were retrieved from patient records,while follow-up data were collected through phone calls and text messages.Chi-square test and Fisher's exact test were used for statistical analysis.Survival analysis was performed based on Kaplan-Meier method,and survival curves of variables were plotted using GraphPad Prism 9.The significance level was set at α = 0.05 for all tests to determine statistical accuracy.Results HE staining revealed a distinctive tissue architecture in HAS,characterized by the coexistence of normal gastric epithelium,areas exhibiting hepatocyte-like differentiation in gastric adenocarcinoma,and common gastric adenocarcinoma regions in the same tumor tissue.Correlation analysis revealed a higher positive rate of caudal type homeobox 2 immunohistochemical staining in tumor tissue from AFPGC patients than that from HAS patients(85.0%vs 66.7%,P =0.032).The positive rates of hepatocyte-like differentiation markers in tumor tissues from HAS patients were as follows:alpha-fetoprotein(AFP,41.0%),glutamine synthetase(41.0%),spalt-like transcription factor 4(41.0%),hepatocyte(64.1%),and glypican-3(64.1%).There was no significant difference in the 3-year postoperative survival analysis between AFPGC and HAS,but the 5-year postoperative prognosis of HAS was worse than that of AFPGC(P =0.062).The 3-year(P =0.030)and 5-year(P = 0.022)prognosis of AFPGC group with serum AFP≥60.4 μg/L was significantly worse than that of AFPGC group with serum AFP<60.4 μg/L.The 3-year(P =0.050)and 5-year(P =0.084)prognosis of HAS group with serum AFP<20 μg/L was significantly worse than that of HAS group with elevated serum AFP.Conclusion Currently,the diagnosis of HAS relies on histopathological examination,which is prone to missed diagnosis.The long-term prognosis following surgical intervention for HAS is inferior to that for AFPGC.Serum AFP≥60.4 μg/L serves as a prognostic risk factor for AFPGC,whereas diminished serum AFP expression represents a prognostic risk factor for HAS.
关键词
甲胎蛋白/甲胎蛋白阳性胃癌/胃肝样腺癌/临床病理因素/生存分析/预后危险因素
Key words
alpha-fetoprotein/alpha-fetoprotein-positive gastric cancer/hepatoid adenocarcinoma of the stomach/clinicopathological factors/survival analysis/prognostic risk factors
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