The Clinicopathological Characteristics of Alpha-Fetoprotein-Producing Adenocarcinoma of the Gastrointestinal Tract-A Single-Center Retrospective Study

Xiang-Xing Kong; Xin-Lin Li; Yu Tian; Qian-Cheng Ye; Xiao-Ming Xu; Yue Liu; Qi Yang; Li-Na Zhang; Yan-Xia Mei; Ji-Hang Wen; Qian Xiao; Jing-Song Li; Ke-Feng Ding; Jun Li

doi:10.3389/fonc.2021.635537

The Clinicopathological Characteristics of Alpha-Fetoprotein-Producing Adenocarcinoma of the Gastrointestinal Tract-A Single-Center Retrospective Study

Front Oncol. 2021 Apr 29:11:635537. doi: 10.3389/fonc.2021.635537. eCollection 2021.

Authors

Xiang-Xing Kong^{1

2}, Xin-Lin Li^{1

2

3}, Yu Tian⁴, Qian-Cheng Ye⁴, Xiao-Ming Xu^{2

5}, Yue Liu^{1

2}, Qi Yang^{2

5}, Li-Na Zhang^{1

2}, Yan-Xia Mei^{1

2}, Ji-Hang Wen^{1

2}, Qian Xiao^{1

2}, Jing-Song Li^{4

6}, Ke-Feng Ding^{1

2}, Jun Li^{1

2}

Affiliations

¹ Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
² Zhejiang University Cancer Center, Hangzhou, China.
³ Department of Breast Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.
⁴ Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China.
⁵ Department of Pathology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁶ Research Center for Healthcare Data Science, Zhejiang Lab, Hangzhou, China.

Abstract

Alpha-fetoprotein (AFP)-producing adenocarcinoma from the gastrointestinal tract (APA-GI) is a rare type of highly malignant tumor with a poor prognosis. It may originate from any site along the GI tract with similar clinicopathological characteristics. As limited research had ever described the characteristics of APA-GI, the present article intends to systemically investigate the clinicopathological characteristics of APA-GI from a single center's retrospective study to deepen the understanding of the disease. A total of 177 patients pathologically diagnosed with APA-GI between 2010 and 2017 at the Second Affiliated Hospital of Zhejiang University, School of Medicine, were included. Also, clinical data of 419 gastric cancers and 609 colorectal cancers from The Cancer Genome Atlas database were also extracted. Clinical information of patients from Second Affiliated Hospital of Zhejiang University, School of Medicine, was collected, and a median follow-up of 14.5 months was performed to investigate clinical characteristics of APA-GI. For the pathological characteristics of APA-GI, hematoxylin-eosin sections were reviewed, and immunohistochemistry of AFP was performed. The results showed that the primary tumor could develop through the whole GI tract, including the esophagus (0.6%), stomach (83.1%), duodenum (1.1%), ileum (0.6%), appendix (0.6%), colon (5.1%), and rectum (7.9%). Hepatoid adenocarcinoma is the main pathological feature of APA-GI. AFP expression level in tumor tissue was not strictly associated with serum AFP or hepatoid differentiation. The prognosis of APA-GI was worse than that of common adenocarcinoma of the GI tract and liver metastasis, and high AFP levels suggest poor prognosis in patients with APA-GI. Therefore, the present study was the first research to systemically explore the clinicopathological characteristics of APA-GI. APA-GI occurs through the whole GI tract with a significantly worse prognosis than common adenocarcinoma of GI. APA-GI should be regarded as one kind of disease for its similar clinicopathological characteristics within patients.

Keywords: AFP-producing; adenocarcinoma; clinical characteristic; gastrointestinal; pathological characteristic.