Mao Jia-Xi, Liu Cong, Zhao Yuan-Yu, Ding Guo-Shan, Ma Ji-Qing, Teng Fei, Guo Wen-Yuan
Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Naval Medical University Shanghai 200003, China.
Department of General Surgery, Changhai Hospital, Naval Medical University Shanghai 200433, China.
Am J Transl Res. 2021 Mar 15;13(3):898-922. eCollection 2021.
This study aimed to provide diagnostic clues for patients with elevated serum alpha-fetoprotein (AFP) in the absence of liver tumors and rectify some previously confused concepts about hepatoid carcinoma of the lung through a systematic review on hepatoid adenocarcinoma of the lung (HAL). A thorough search for original articles on HAL published prior to November 2020 was performed using the PubMed, EBSCOhost, Embase, WanFang Data, and China National Knowledge Infrastructure (CNKI) databases. Ninety-four patients from 88 studies met the eligibility criteria. HAL was rare and mainly occurred among male Asian smokers in their 60 s, presenting with cough, hemoptysis, chest pain, dyspnea and/or weight loss, as well as elevated serum AFP with a mass usually in the right upper lung lobe but no liver masses. Hepatoid differentiation regions, acinar or papillary structures in tumor tissues, and positive immunohistochemical expression of AFP, HepPar-1, and CK8/18 were crucial indicators for the diagnosis of HAL. Surgery-based strategies were recommended for stage I-III patients, while stage IV patients were mainly treated with chemotherapy-based strategy. The 1-, 3-, and 5-year overall survival rates were 40%, 35%, and 19%, respectively. The 1-year relapse-free survival rate was 58%. The postoperative monitoring of AFP contributed to the early detection of tumor recurrence, with a positive rate of 71.43%. In conclusion, patients with elevated serum AFP levels without any detectable hepatic lesions should be evaluated for the possibility of HAL.
本研究旨在通过对肺肝样腺癌（HAL）进行系统综述，为血清甲胎蛋白（AFP）升高但无肝肿瘤的患者提供诊断线索，并纠正一些此前关于肺肝样癌的混淆概念。使用PubMed、EBSCOhost、Embase、万方数据和中国知网（CNKI）数据库，全面检索了2020年11月之前发表的关于HAL的原始文章。来自88项研究的94例患者符合纳入标准。HAL较为罕见，主要发生于60多岁的亚洲男性吸烟者中，表现为咳嗽、咯血、胸痛、呼吸困难和/或体重减轻，血清AFP升高，肿块通常位于右上肺叶，但无肝肿块。肿瘤组织中的肝样分化区域、腺泡或乳头结构，以及AFP、HepPar-1和CK8/18的免疫组化阳性表达是诊断HAL的关键指标。建议I-III期患者采用以手术为主的治疗策略，而IV期患者主要采用以化疗为主的治疗策略。1年、3年和5年总生存率分别为40%、35%和19%。1年无复发生存率为58%。术后监测AFP有助于早期发现肿瘤复发，阳性率为71.43%。总之，血清AFP水平升高但未发现任何肝脏病变的患者应评估HAL的可能性。
