| Background and purposeLung cancer is a common malignant tumor.According to the American Cancer Center,the five-year survival rate of lung cancer from 2009 to 2015 was 19%,which is the lowest among all cancers,second only to pancreatic cancer(9%)and liver cancer(18%).In 2015,the World Health Organization divided lung cancer into two categories:small cell lung cancer and non-small cell lung cancer.Hepatoid adenocarcinoma of lung is a rare subtype of NSCLC,which is named because of its similar cell morphology to hepatocellular carcinoma.In addition to lung tissue,hepatoid adenocarcinoma also occurs in the stomach,ovary,gallbladder,pancreas and uterus.Ishikura H et al first proposed the concept of hepatoid adenocarcinoma of the lung in 1990,and put forward the diagnostic criteria of HAL:①contains typical acinar or papillary adenocarcinoma,②types of primary hepatocellular carcinoma,and expresses AFP.Haninger et al reported two cases of HAL,with signet ring cell components in 2014 and modified the diagnostic criteria from the perspective of morphology and immunophenotype.This study suggests that:①HAL can be a simple HAC,or contain typical acinar or papillary adenocarcinoma,signet ring cell carcinoma or neuroendocrine carcinoma.②liver differentiation markers and positive expression of AFP are not mandatory requirements for diagnosis,but need to have the morphological characteristics of hepatocytes.At present,there are few literatures about HAL at home and abroad,and there are only a few case reports and meta-analysis.Based on 78 HAL patients registered in SEER database and 2 HAL patients treated in the first affiliated Hospital of Zhengzhou University,this paper makes a retrospective analysis to explore the clinicopathological characteristics and prognostic factors of HAL patients.MethodsThrough SEER*Stat 8.3.8,Search SEER 18regs research data+hurricane katrina impacted Louisiana cases,nov 2018 sub(1975—2016 varying),A total of 78 patients with hepatoid adenocarcinoma of the lung registered in North America from 2001 to 2016 were obtained,The age,race,sex,marital status,year of diagnosis,location of primary focus,histological grade,operation,radiotherapy and chemotherapy,distant metastasis,stage and survival time of the 78 patients were collected.2 patients diagnosed with HAL from 2016 to 2019 were collected from the Department of Pathology of the first affiliated Hospital of Zhengzhou University.OS was obtained by medical record system or telephone follow-up.A total of 80 patients,SPSS 25.0 statistical software was used to process the data,Kaplan-Meier method was used for survival analysis,log-rank test was used to compare the differences between groups,and Cox regression was used for multivariate analysis.All statistical tests were bilateral probability test,and the difference was statistically significant(P<0.05).Results1.A total of 80 patients with HAL were included(including 78 cases in SEER database and 2 cases in the first affiliated Hospital of Zhengzhou University).There were 42 males and 38 females,with a male-to-female ratio of 1.2.The age was 36-90 years old,the average age was 65.19±11.87 years old,and the median age was 63.50 years old.37 cases were married.The primary lesions were located in the upper lobe of the lung in 44 cases and in the lower lobe in 16 cases.7 cases were treated by operation and 73 cases were not.38 cases received radiotherapy and 38 cases received chemotherapy.Distant metastasis occurred at the first visit:bone metastasis(29.82%),brain metastasis(15.79%)and liver metastasis(12.50%).There were 3 cases of moderately differentiated type,20 cases of poorly differentiated type,4 cases of undifferentiated type and no well differentiated type.There were 2 cases of stage Ⅰ,4 cases of Ⅱ,7 cases of Ⅲ and 30 cases of Ⅳ.2.10 patients with a total survival time of 0 months in this cohort were deleted,and the remaining 70 patients had complete follow-up data.As of the follow-up date,15 cases survived(21.43%)and 55 cases died(78.57%).The 1-year survival rate,2-year survival rate and 5-year survival rate of 70 patients were 28.33%,13.87%and 5.71%,respectively,and the median overall survival time was 5 months.6 patients received surgery-based comprehensive treatment,4 patients survived(the overall survival time was 8,55,74,139 months respectively),and 2 patients died(the total survival time was 16 months and 29 months respectively).The prognostic factors of hepatoid adenocarcinoma of the lung were related to whether they received surgical treatment(P=0.001)and the stage of the tumor(P=0.02),but not with age,sex,marital status,location of the target focus,chemotherapy or radiotherapy(P>0.05).Gender,operation,radiotherapy,chemotherapy,tumor stage(divided into stage Ⅰ-Ⅲand stage Ⅳ)and diagnostic age(divided into<65 years old and≥65 years old groups)were included in COX regression multivariate analysis.The results show that Surgery and tumor stage are positive prognostic factors of OS in patients with HAL,but have nothing to do with sex,radiotherapy,chemotherapy and diagnostic age.Conclusion1.Hepatoid adenocarcinoma of the lung is common in the elderly,the target focus is often located in the upper lobe of the lung,immunohistochemistry has heterogeneity,most of them are diagnosed in the Ⅳ stage,and the prognosis is poor.2.The prognosis is related to operation and staging.Early diagnosis and operation-based comprehensive treatment can effectively prolong the overall survival time of patients. |
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