Hou Zan, Xie Jiaqing, Zhang Li, Dai Gangyi, Chen Yuanhang, He Lang
Department of Oncology, The Affiliated Fifth People's Hospital of Chengdu University of TCM, Chengdu Fifth People's Hospital, Chengdu, China.
Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
Front Oncol. 2021 Aug 6;11:702216. doi: 10.3389/fonc.2021.702216. eCollection 2021.
We report the first case of hepatoid adenocarcinoma of the lung (HAL) with PIK3CA mutation. In addition, we analyzed data from HAL cases over the past 40 years to study its main treatment methods, prognosis, and the relationship between prognosis and the serum alpha-fetoprotein (AFP) level before treatment.
We report a 66-year-old male case who was diagnosed with locally advanced HAL with PIK3CA mutation and carried out a systematic literature search for HAL cases documented between 1981 and 2020. General patient information including case characteristics was extracted and summarized. The median OS (mOS) of HAL patients was determined using the KM survival curve. The Cox proportional hazards regression model was used to evaluate the effect of tumor size, location, and serum AFP value before treatment and radical surgery (RS) on the prognosis of patients.
A total of 46 studies including 51 HAL patients was included in our review. Our study revealed that 52.9% of tumors were located in the upper lobe of the right lung. The proportion of serum AFP-positive patients before treatment, early-stage patients (TNM stage I and II), and patients who had received surgery were 69.2%, 34.1%, and 40%, respectively. The mOS of HAL patients was 16.0 months. The 2-year and 5-year survival rates of the patients were 35.3% and 8.0%, respectively. In the subgroup analysis, the 2-year survival rate for patients who received RS was 62.5%, while for patients who were unable to undergo RS, it was only 12.5% ( = 0.009). The Cox proportional hazards regression model indicated that RS can significantly improve the prognosis of HAL patients ( = 0.011), although the location and size of tumor as well as the serum AFP value before treatment had no significant effect on their prognosis ( = 0.82, = 0.96, = 0.25).
HAL patients have a poor prognosis, and the survival benefits for patients receiving chemoradiotherapy or chemotherapy alone appear to be limited. We demonstrate statistically for the first time that pretreatment serum AFP values are not related to the prognosis of HAL patients and RS can significantly improve patient prognosis.
我们报告首例伴有PIK3CA突变的肺肝样腺癌（HAL）病例。此外，我们分析了过去40年中HAL病例的数据，以研究其主要治疗方法、预后以及预后与治疗前血清甲胎蛋白（AFP）水平之间的关系。
我们报告一例66岁男性病例，该病例被诊断为伴有PIK3CA突变的局部晚期HAL，并对1981年至2020年间记录的HAL病例进行了系统的文献检索。提取并总结了包括病例特征在内的一般患者信息。使用KM生存曲线确定HAL患者的中位总生存期（mOS）。采用Cox比例风险回归模型评估肿瘤大小、位置、治疗前血清AFP值以及根治性手术（RS）对患者预后的影响。
我们的综述共纳入46项研究，包括51例HAL患者。我们的研究显示，52.9%的肿瘤位于右肺上叶。治疗前血清AFP阳性患者、早期患者（TNM分期I和II期）以及接受手术患者的比例分别为69.2%、34.1%和40%。HAL患者的mOS为16.0个月。患者的2年和5年生存率分别为35.3%和8.0%。在亚组分析中，接受RS患者的2年生存率为62.5%，而无法接受RS患者的2年生存率仅为12.5%（P = 0.009）。Cox比例风险回归模型表明，RS可显著改善HAL患者的预后（P = 0.011），尽管肿瘤的位置和大小以及治疗前血清AFP值对其预后无显著影响（P = 0.82、P = 0.96、P = 0.25）。
HAL患者预后较差，单独接受放化疗或化疗的患者生存获益似乎有限。我们首次通过统计学证明，治疗前血清AFP值与HAL患者的预后无关，RS可显著改善患者预后。
