| The WHO classification of gastrointestinal tumours defines hepatoid carcinoma as an adenocarcinoma of extrahepatic origin with morphological evidence of hepatocellular diflferentiation.Gastric hepatoid adenocarcinoma is the most common hepatoid adenocarcinoma,the clinical manifestations are lack of specificity,often accompanied by elevated serum AFP,pathological diagnosis is the gold standard for the diagnosis of gastric hepatoid adenocarcinoma,immunohistochemical examination plays an important role in which the malignant degree is high,rapid progress,prone to lymph node and liver metastases,poor prognosis.ObjectiveFirst,by collecting and sorting out the literature related to gastric hepatoid adenocarcinoma published at home and abroad,the clinicopathological characteristics and prognostic factors of this rare tumor were summarized and analyzed,and the differences in clinical cases and prognosis of gastric hepatoid adenocarcinoma between people in mainland China and those in other regions were compared.Secondly,combined with the case data of patients with gastric hepatoid adenocarcinoma in the first medical center of PLA general hospital,the disease characteristics of gastric hepatoid adenocarcinoma were analyzed.Third,based on the tumor tissue samples of patients with gastric hepatoid adenocarcinoma in the first medical center of the PLA general hospital,the density of tumor and surrounding inflammatory cells was analyzed by immunohistochemical method,the immune scoring method for gastric hepatoid adenocarcinoma was established,and its value in the prognosis of gastric hepatoid adenocarcinoma was evaluated.Methods1.Literature related to gastric hepatoid adenocarcinoma before December 31,2018 was retrieved through Pubmed,Embase,The cochrane Library,three English full-text databases,and four Chinese full-text databases,namely The general publication database of Chinese academic journals,wanfang medical database,China biomedical literature database,and wipp Chinese biomedical journal database.A total of 259 cases with detailed prognostic information were obtained,and the relationship between the characteristics of different clinical cases and the prognosis of patients was analyzed by univariate and multivariate survival analysis,and the population in mainland China and other regions were distinguished for comparative analysis.2.Clinical data and tumor tissue samples of 53 patients who were admitted to the first medical center of PLA general hospital on January 1,2006 and pathologically diagnosed with gastric hepatoid adenocarcinoma after operation on June 20,2018 were collected and sorted out.On the one hand,clinical pathological information was collected to analyze the characteristics of gastric hepatoid adenocarcinoma,and the prognosis was analyzed.On the other hand,the distribution of CD3,CD8,CD45RO and CD66b in tumor center and border region was detected by immunohistochemical staining of archived tumor tissue samples,and the immune scoring method was established to verify the prognostic effect of the immune scoring.Results1.In the first part,a total of 236 cases with access to gender information included 175 males(74.2%)and 61 females(25.8%),with no significant difference between the two groups.The overall mean age of onset was 62.7 10.14 years.There were 86(48%)patients with T4 stage and 49(27.4%)patients with T3 stage.The proportion of T4 stage in mainland China was higher than that in other regions(65.1%(69/106)and 23.3%(17/73),respectively,P<0.001).87.3%of the patients had AFP positive immunohistochemistry.Compared with other regions,patients in mainland China chose surgical treatment in a higher proportion(84.5%(142/154)and 82.5(66/80),P=0.025).The median overall survival time was 15 months,and the overall 3-year survival rate was 21.7%.K-M single factor analysis,the male prognosis is worse(P=0.04),more than female patients older than 60,the prognosis is worse(P=0.019),and have significantly worse outcomes in patients with Liver metastases(P<0.001),the prognosis of patients with surgical treatment of significantly better(P<0.001),chemotherapypatients compared with patients who were not chemotherapybetter prognosis(P=0.028).COX multivariate survival analysis indicated that Liver metastases was highly correlated with the prognosis of patients(P=0.005),and age(P=0.022),surgery(P=0.016),and chemotherapy(P=0.044)were correlated with the prognosis of patients.2.In the second part,a total of 53 patients were diagnosed with gastric hepatoid adenocarcinoma accounting for 0.86%(53/6147)of the patients with gastric cancer in the same period.Only 2 cases(3.8%)were diagnosed as gastric hepatoid adenocarcinoma before operation.The incidence of gastric antrum was higher(19/53,35.8%)and the incidence of lesser curvature was higher(30/41,73.2%).Ulcerative type was more common(38/53,71.7%).Effective survival information was obtained in 42 patients.K-m single-factor analysis showed that distant metastasis,tumor length and diameter,T staging,proportion of positive lymph nodes,inmunohistochemical expression of Her2,ISHAS and ISGC were significantly correlated with the prognosis of patients.Multivariate COX survival analysis suggested that distant metastasis,proportion of positive lymph nodes and ISHAS were still significantly correlated with prognosis(all P values were less than 0.05).Conclusions1.Gastric hepatoid adenocarcinoma occurs more frequently in males than females,mainly in the gastric antrum,mainly in the form of ulcer,and is often poorly differentiated.once distant metastasis occurs,especially liver metastases,it indicates a poor prognosis of patients.Patients with gastric hepatoid adenocarcinoma should actively choose surgical treatment,and chemotherapyalso plays a positive role in improving the prognosis of patients.This study suggests that the age of onset is earlier,the depth of invasion is deeper and the treatment is more active in mainland China than in other regions.2.0ur study suggests smoking drinking history and gastric adenocarcinoma were not associated with the prognosis of liver samples,inflammatory cells in peripheral blood of tumor,such as grain leaching ratio,blood spray than in the evaluation of the prognosis of gastric adenocarcinoma from liver samples effect is poor,Her2 expression in tumor tissues and tumor size may and prognosis related,whether tumor distant metastasis i5 related to the prognosis of patients with significant tumor positive lymph node ratio is better than N staging of the tumor prognosis evaluation.3.Immunohistochenical staining was performed on inflammatory cells in tumor microenvironment to establish the Immunoscore method,which was effective for prognosis evaluation of patients with gastric hepatoid adenocarcinoma. |
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