| Background Hepatoid adenocarcinoma of the stomach is a specific type of primary gastric adenocarcinoma with a histological component, mimicking hepatocellular carcinoma morphologically as well as immunophenotypically, characterized clinically by a poor prognosis. The objective of this study is to investigate the clinicopathological and prognostic features of the hepatoid adenocarcinoma of the stomach. To analyze the clinical manifestations, so the diagnosis of hepatoid adenocarcinoma of the stomach (HAS) may be made and treatment instituted as early as possible.Methods We had systematically searched for either published on the HAS all over the world from January 1985 to December 2004, by electronic and manual retrieving, and other means such as s with related experts, etc. The Kaplan-Meier method was used to estimate clinicopathological features and patient survival, and differences in the probabilities were evaluated using the log-rank test. Cox's proportional hazards model was performed to identify factors that were independently associated with the prognosis. Statistical analysis was carried out using SPSS 13.0. In the same time, a total of 9 of HAS patients undergoing surgical resection at Tianjin Cancer Hospital between 2000 and 2005 were included in this study. Routine pathological and immunohistochemcal data were studied in the 9 cases of HAS.Results From January 1985 to December 2004, Totally 37 pieces of literatures and 125 cases were retrieved. There were 83 men and 42 women among the 125 patients with ages ranging from 40 to 87 years. The average age of the patients was 63.2 years, and the male-to-female ratio was 1.976 : 1. In most of these patients, the tumors occurred mainly at the antrum. 81.6% patients had an Alpha-fetoprotein higher than normal, and the average serum AFP level was 279130ng/ml (range, 0-21770000ng/ml). The average maximal tumor diameter was 4.8cm± 3. lcm (range, 1.6-15cm). 63. 2% patients had the Borrmann I - II tumors. Among the 125 patients, the metastases of HAS appeared in 117 patients, and in most of the reported patients, metastases to the liver and/or lymph nodes were detected preoperatively.In the literature, 69 cases described the survival status, and the median follow-up was 15.34 months (range, 1-96 months). The one, two, three and three year over-all survival rates of the patients were 54%, 21%, 16% and 13%. A total of 47 patients were died. The exploratory analysis was used to identify risk factors for survival in patients with HAS. Factors including the patient's age, sex, tumor location, serum AFP level, serum CEA level, Borrmann type, operation, chemotherapy, the average maximal tumor diameter, the depth of tumour invasion, infiltrate depth, liver and lymph nodes metastases were analyzed for their association with survival. Among them, the patient's age >60 years, liver and lymph nodes metastases were factors associated with survival in univariate analysis. In multivariate analysis, only liver and lymph nodes metastases were the determinants for survival in patients with HAS. However, there were no statistically significant impacts on recurrence for serum AFP and CEA.Routine pathological and immunohistochemcal data were studied in the 9 cases of HAS at Tianjin Cancer Hospital. We found that prominent intravascular tumor thrombi were present in the submucosal, muscular and subserosal layers in all cases, and immunohistochemical positivity for ACT, AFP, AAT and CEA were 9, 6,5 and 2 cases.Conclusions Hepatoid adenocarcinoma of the stomach, a rare and specific type of primary gastric adenocarcinoma is a highly malignant neoplasm, with a histological component, mimicking hepatocellular carcinoma morphologically as well as immunophenotypically, characterized clinically by a poor prognosis. These tumours have a strong tendency for vascular invasion. |
PDF Full Text Request