Kong Xiang-Xing, Li Xin-Lin, Tian Yu, Ye Qian-Cheng, Xu Xiao-Ming, Liu Yue, Yang Qi, Zhang Li-Na, Mei Yan-Xia, Wen Ji-Hang, Xiao Qian, Li Jing-Song, Ding Ke-Feng, Li Jun
Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Zhejiang University Cancer Center, Hangzhou, China.
Front Oncol. 2021 Apr 29;11:635537. doi: 10.3389/fonc.2021.635537. eCollection 2021.
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.
胃肠道产甲胎蛋白腺癌（APA-GI）是一种罕见的高恶性肿瘤，预后较差。它可起源于胃肠道的任何部位，具有相似的临床病理特征。由于以往关于APA-GI特征的研究有限，本文旨在通过单中心回顾性研究系统地调查APA-GI的临床病理特征，以加深对该疾病的认识。纳入了2010年至2017年在浙江大学医学院附属第二医院病理诊断为APA-GI的177例患者。此外，还从癌症基因组图谱数据库中提取了419例胃癌和609例结直肠癌的临床数据。收集了浙江大学医学院附属第二医院患者的临床信息，并进行了中位随访14.5个月以调查APA-GI的临床特征。对于APA-GI的病理特征，复查苏木精-伊红切片，并进行甲胎蛋白免疫组化。结果显示，原发性肿瘤可发生于整个胃肠道，包括食管（0.6%）、胃（83.1%）、十二指肠（1.1%）、回肠（0.6%）、阑尾（0.6%）、结肠（5.1%）和直肠（7.9%）。肝样腺癌是APA-GI的主要病理特征。肿瘤组织中甲胎蛋白表达水平与血清甲胎蛋白或肝样分化无严格关联。APA-GI的预后比胃肠道常见腺癌和肝转移更差，高甲胎蛋白水平提示APA-GI患者预后不良。因此，本研究是首次系统探索APA-GI临床病理特征的研究。APA-GI发生于整个胃肠道，预后明显比胃肠道常见腺癌差。鉴于患者的临床病理特征相似，APA-GI应被视为一种疾病。
