The prognosis of hepatoid adenocarcinoma of the stomach: a propensity score-based analysis

Abstract

Background: To investigate whether there is a distinct difference in prognosis between hepatoid adenocarcinoma of the stomach (HAS) and non-hepatoid adenocarcinoma of the stomach (non-HAS) and whether HAS can benefit from radical surgery. Methods: We retrospectively reviewed 722 patients with non-HAS and 75 patients with HAS who underwent radical gastrectomy between 3 November 2009 and 17 December 2018. Propensity score matching (PSM) analysis was used to eliminate the bias among the patients in our study. The relationships between gastric cancer type and overall survival (OS) were evaluated by the Kaplan-Meier method and Cox regression. Results: Our data demonstrate that there was no statistically significant difference in the OS between HAS and non-HAS {K-M, P = log rank (Mantel-Cox), (before PSM P = 0.397); (1:1 PSM P = 0.345); (1:2 PSM P = 0.195)}. Moreover, there were no significant differences in the 1-, 2-, or 3-year survival rates between patients with non-HAS and patients with HAS (before propensity matching, after 1:1 propensity matching, and after 1:2 propensity matching). Conclusion: HAS was generally considered to be an aggressive gastric neoplasm, but its prognosis may not be as unsatisfactory as previously believed.

Hepatoid Adenocarcinoma of the Stomach: Current Perspectives and New Developments

“…Macroscopically, according to Borrmann's classification, majority of patients were type III with poor differentiation and elevated serum AFP levels. The most common primary locations of these tumors were the antrum and body (26,33). Microscopically, HAS was defined as a tumor with the resemble features of hepatoid adenocarcinomas with hematoxylin and eosin (H&E) stains, consisting of large eosinophilic cells with a similar morphology to HCC, which exhibiting trabecular or solid nested arrangement, separated by sinusoidal vascular channels (33)(34)(35).…”

“…The most common primary locations of these tumors were the antrum and body (26,33). Microscopically, HAS was defined as a tumor with the resemble features of hepatoid adenocarcinomas with hematoxylin and eosin (H&E) stains, consisting of large eosinophilic cells with a similar morphology to HCC, which exhibiting trabecular or solid nested arrangement, separated by sinusoidal vascular channels (33)(34)(35). Assorted degrees differentiation of clear cells imitating embryonic foregut epithelium can also be found, indicating the differentiation of fetal enteroblastic.…”

“…HAC had diffuse expression of AFP, HepPar-1, glypican 3(GPC3), and spalt-like transcription factor 4 (SALL4) with a moderate sensitivity (27). IHC staining for Carcinoembryonic proteins (AFP, SALL4, and GCP3) shows strong diffuse staining of the hepatoid element, suggesting both hepatoid and intestinal mucin phenotype differentiation (33). The intestinal component usually stains for CDX-2 (33,38).…”

“…IHC staining for Carcinoembryonic proteins (AFP, SALL4, and GCP3) shows strong diffuse staining of the hepatoid element, suggesting both hepatoid and intestinal mucin phenotype differentiation (33). The intestinal component usually stains for CDX-2 (33,38). HepPar-1 and Arginase-1 immunostainings are regarded as highly sensitive and specific markers of HCC, while the positive staining of these markers can be detected in some HAC, causing certain difficulties in distinguishing HAS from HCC (37,39).…”

“…HAS patients had notably lower survival rates and disease-free survival (DFS) compared to those with other types. It is revealed that the 5-year DFS of HAS patients was only 20.7% (2,33,91). It was concluded that pTNM stage, portal vein thrombosis, vascular invasion, and adjuvant treatments were independent risk factors for DFS and pTNM stage, entirely surgical resection, and adjuvant therapy were independent risk factors for disease-specific survival (DSS) (2).…”