Cheng Yuqing, Zhang Xinwen, Li Ting, He Chongfang, Yang Haojun, Zhou Xiaoli, Huang Qin
Department of Pathology, Changzhou No. 2 People's Hospital, Nanjing Medical University, Changzhou.
Graduate School, Dalian Medical University, Dalian.
Histopathology. 2025 Apr;86(5):715-727. doi: 10.1111/his.15379. Epub 2024 Dec 10.
Alpha-fetoprotein (AFP)-producing colorectal adenocarcinoma (AFPCRA) is uncommon, with obscure clinicopathological features and prognosis.
In this retrospective comparison study on surgically resected colorectal adenocarcinomas (CRA, n = 2389), we investigated and compared clinicopathological and prognostic features between AFPCRA cases with elevated pre-operative serum AFP levels, as the AFPCRA study group (n = 49, 2.1%), and the exact sex-, age- and stage-matched CRA cases as the control group at a 1:2 ratio during the study period from 2011 to 2021. The AFPCRA group was further divided into low and high serum AFP-level subgroups at the cut-off of 8.4 ng/ml. Compared to the control group, the AFPCR group showed a significantly higher frequency in extramural venous invasion, intermediate/high tumour budding grade, poor tumour differentiation, liver and distant metastases, mixed and hepatoid adenocarcinomas. The 5-year overall survival rate was significantly lower in the AFPCRA group (69.2%) than in the control (87.2%) (P = 0.002). The high AFP-level AFPCRA subgroup displayed a significantly higher prevalence of the left colon location than the low AFP-level subgroup. Risk factors of overall survival for the AFPCRA group included lymphovascular, perineural and extramural venous invasion, poor tumour differentiation, tumour budding grade, distant metastasis, pN, pM and pathological summary stages, while distant metastasis was the only independent prognostic risk factor.
AFPCRA was rare and may be associated with aggressive behaviour and poor prognosis. These preliminary findings in this single-centre study remain to be validated by future studies with larger samples.
产生甲胎蛋白（AFP）的结直肠腺癌（AFPCRA）并不常见，其临床病理特征和预后尚不明确。
在这项对手术切除的结直肠腺癌（CRA，n = 2389）进行的回顾性比较研究中，我们调查并比较了术前血清AFP水平升高的AFPCRA病例（AFPCRA研究组，n = 49，占2.1%）与在2011年至2021年研究期间按1:2比例精确匹配性别、年龄和分期的CRA病例（作为对照组）之间的临床病理和预后特征。AFPCRA组进一步按照8.4 ng/ml的临界值分为低血清AFP水平亚组和高血清AFP水平亚组。与对照组相比，AFPCR组在壁外静脉侵犯、中/高肿瘤芽生分级、肿瘤分化差、肝转移和远处转移、混合型和肝样腺癌方面的发生率显著更高。AFPCRA组的5年总生存率（69.2%）显著低于对照组（87.2%）（P = 0.002）。高AFP水平的AFPCRA亚组左半结肠部位的患病率显著高于低AFP水平亚组。AFPCRA组总生存的危险因素包括淋巴管、神经周围和壁外静脉侵犯、肿瘤分化差、肿瘤芽生分级、远处转移、pN、pM和病理综合分期，而远处转移是唯一独立的预后危险因素。
AFPCRA罕见，可能与侵袭性行为和预后不良有关。本单中心研究的这些初步发现有待未来更大样本量的研究进行验证。
