| Objective:1?The clinical and pathological characteristics of HAS were retrospectively analyzed and compared with that of non-HAS gastric adenocarcinoma,so as to form a more complete multi-dimensional diagnosis system of HAS.2?By studying prognostic factors of HAS,prognosis can be guided.3?Based on the research and analysis of gene protein level,it provides clues for the follow-up research of pathogenesis and targetedtherapy in HAS.Methods:1?From January 2013 to March 2018,according to the strict inclusion and exclusion criteria,576 cases were enrolled onto the study from the 1320 cases of patients with gastric cancer,and 5patients have been confirmed of HAS among the enrolled patients.2?The histopathological specimens of the enrolled cases were diagnosed for the second time by 2 physicians qualified for pathological diagnosis in the southeast universiry affiliated zhongda hospital and histopathological specimens from 10 newly discovered cases showed areas of hepatoid differentiation.Thus,a total of 15 HAS cases were found.In addition,30 cases of common gastric adenocarcinoma patients were randomly selected as the control group.3?The information of patients in the HAS group and the control group were improved by collecting the existing case data,detecting the missing pathological indicators again and telephone follow-up.4?The clinicopathological features of the two groups were compared and the treatment and prognosis of 15 HAS patients were analyzed.Resaults:1?15 HAS patients were enrolled in this study,the average age was 65.5±7.3 years old,and the ratio of male to female was 4:1.The most common first diagnosis was Abdominal pain,and the most of the tumor sites were located in the cardia(46.7%)and the corpus(40.0%).The HAS patients were mostly stage IV(40.0%),the differentiation was mainly poorly differentiated adenocarcinoma(86.7%),the lymph node involvement occurred in 11 cases(73.3%),and the distant metastasis occured in 6 cases(40.0%).11 HAS patients were recorded the largest diameter of the tumor,neurological and vascular invasion,in which the largest diameter of the tumor ranging from 4 to 14 cm,with an average maximum diameter of 5.4±3.2 cm,8 patients(72.7%)invaded the nerve,and 8 patients(72.7%)invaded the vascular.In the control group,30 cases of common gastric adenocarcinoma were included,with an average age of 61.6±10.0 years old,and the ratio of male to female was 2:1.The most common first diagnosis was Abdominal pain,and the most of the tumor sites were located in the antrum(33.3%)and the corpus(30.0%).The control patients were mostly stage III(43.3%),and the differentiation was mainly poorly differentiated adenocarcinoma(73.3%).lymph node involvement occurred in 22 cases(73.3%),and distant metastasis in 4 cases(13.3%).Among them,27 patients were recorded the largest diameter of the tumor,neurological and vascular invasion,in which the largest diameter of the tumor ranging from 0.6 to 18 cm,with an average maximum diameter of 6.0±3.9 cm,19 patients(70.4%)invaded the nerve,and 16patients(59.3%)invaded the vascular.The above clinicopathological features showed no significant difference between the HAS group and the control group(P>0.05).2?Compared with the control group,the serum AFP value of the HAS group was significantly higher,the HAS group was more prone to liver metastasis than the common gastric adenocarcinoma,and the HAS group had higher expression of GPC3,AFP,EGFR and VEGF protein.The above differences were statistically significant(P<0.05).3?The median survival time of patients in the HAS group was 12 months,and the median survival time of patients with common gastric adenocarcinoma was 42 months.The difference between the two groups was statistically significant(P<0.05).4?Univariate analysis showed that tumor markers CEA,TNM staging,lymph node staging,AFP immunohistochemical staining and radical surgery were risk factors for prognosis.After multivariate analysis of the results,it was found that distant metastasis and immunohistochemicalAFP expression levels were independent risk factors for prognosis.Conclusions:1?HAS is a rare type of gastric adenocarcinoma which is more common in middle-aged and elderly men,and there is no special difference of clinical symptoms between HAS and common gastric adenocarcinoma.HAS has higher liver metastasis rate,more poor prognosis,and shorter median survival time than that of common gastric adenocarcinoma;2?The AFP level in peripheral blood of HAS patients is significantly higher than that of patients with common gastric adenocarcinoma which can play an important auxiliary role in the diagnosis of HAS.It is suggeted that detecting the immunohistochemical AFP and GPC3 in gastric adenocarcinoma patients with a marked increase in AFP in serum tests can help to reduce the chance of misdiagnosis and missed diagnosis;3?Distant metastasis and immunohistochemical AFP staining intensity are independent risk factors affecting the prognosis of HAS patients;4?AFP,GPC3,VEGF and EGFR may be potential therapeutic targets of HAS,which is worth further exploration. |
PDF Full Text Request