Immunohistochemical characteristics and potential therapeutic regimens of hepatoid adenocarcinoma of the stomach: a study of 139 cases

Conversion hepatectomy after chemotherapy including nivolumab for multiple liver metastases of hepatoid adenocarcinoma of the stomach: A case report and literature review

INTRODUCTION

Currently, there is no evidence of the effectiveness of surgical intervention for Stage IV gastric cancer (GC); however, there are scattered reports of hepatectomy for liver metastasis of GC after chemotherapy including nivolumab.

PRESENTATION OF CASE

We report a case of a 79-year-old man with a history of laparoscopic distal gastrectomy with D2 lymph node dissection for GC, pathologically diagnosed as hepatoid adenocarcinoma of the stomach (HAS), with a combined positive score (CPS) for programmed death (PD)-ligand 1 was >5. Six months after gastrectomy, magnetic resonance imaging (MRI) showed multiple masses in both lobes of the liver, and the patient was treated with a regimen consisting of nivolumab and capecitabine with oxaliplatin (CapeOX). After 11 courses of nivolumab and CapeOX therapy, MRI revealed reduced tumor sizes in both lobes of the liver. The patient underwent left lateral sectionectomy and partial resection of the liver. No new recurrences were observed, and the patient has survived for 15 months after hepatectomy.

DISCUSSION

The recent emergence of PD-1 inhibitors has improved the prognosis of unresectable advanced or recurrent GC. Hepatectomy for liver metastasis of GC can be effective if the conditions are met. In this case, both the resected gastric tumor and metastasis in the left lateral hepatic segment had a CPS > 5, suggesting that nivolumab with CapeOX therapy could control the disease status from unresectable to resectable liver metastasis.

CONCLUSION

Using multidisciplinary treatment, R0 surgery was successfully performed in a patient with multiple unresectable liver metastases of HAS.

Hepatoid adenocarcinoma of the stomach: discrimination from conventional gastric adenocarcinoma with a computed tomography-based radiomics nomogram

Background

Previous studies found it difficult to differentiate hepatoid adenocarcinoma of the stomach (HAS) from conventional gastric adenocarcinoma (CGA). We aimed to assess the efficacy of a computed tomography (CT)-based radiomics nomogram in identifying HAS.

Methods

Portal phase CT images were collected from 59 patients with HAS and 122 patients with CGA. HAS and CGA were differentiated through univariate analysis of clinical characteristics, serum biochemical biomarkers, and CT features. The construction of the radiomics signature involved the application of the least absolute shrinkage and selection operator (LASSO) regression model. Multivariable logistic regression analysis was employed to establish the CT-based radiomics nomogram.

Results

The separation of HAS patients from CGA patients relied on the serum alpha-fetoprotein (AFP) level and radiomics signature. The area under the curve (AUC) of AFP was 0.726 [95% confidence interval (CI): 0.639-0.801] in the training cohort and 0.681 (95% CI: 0.541-0.800) in the test cohort, whereas the radiomic signature demonstrated a significantly higher AUC of 0.949 (95% CI: 0.895-0.980) in the training cohort and 0.868 (95% CI: 0.749-0.944) in the test cohort. The nomogram model yielded excellent accuracy for identifying HAS, achieving an AUC of 0.970 (95% CI: 0.923-0.992) in the training cohort and 0.905 (95% CI: 0.796-0.968) in the test cohort.

Conclusions

Radiomics analysis offers promise for differentiating HAS from CGA, and the CT-based radiomics nomogram is likely to have significant clinical implications on HAS distinction.

Clinicopathological features of hepatoid adenocarcinoma and non-hepatoid adenocarcinoma of the stomach: A systematic review and meta-analysis

BACKGROUND

Hepatoid adenocarcinoma of the stomach (HAS) is an extremely rare and unique malignant gastric tumor with a significantly worse prognosis than non-hepatoid adenocarcinoma of the stomach (non-HAS). The present study explored the clinicopathological features of HAS and non-HAS patients to provide insights into HAS treatment strategies.

METHODS

From December 26, 2023, we performed a comprehensive search of the PubMed, Web of Science, Cochrane Library, and Embase.com databases for relevant studies. Two authors independently screened the studies, evaluated their quality, extracted data, and performed the analyses. This study was registered with PROSPERO on January 2, 2024.

RESULTS

Nine retrospective studies were included for analysis after screening 833 articles. A total of 350 and 924 patients were enrolled in the HAS and non-HAS groups, respectively. While no significant differences were observed in age, sex, tumor size, T3 or T4 stage, and N2 or N3 stage between the two groups, the HAS group exhibited higher rates of lymph node metastasis (OR = 1.93, 95% CI: 1.19-3.13, p = 0.007), liver metastasis (OR = 3.45, 95% CI: 2.26-5.28, p < 0.001), and vascular invasion (OR = 2.76, 95% CI: 2.05-3.71, p < 0.001). Additionally, the HAS group had lower 3-year survival rates (HR = 2.35, 95% CI: 1.70-3.25, p < 0.001) and 5-year survival rates (HR = 3.63, 95% CI: 1.49-8.88, p = 0.005), but lower rates of lymphatic permeation (OR = 0.68, 95% CI: 0.47-0.99, p = 0.040).

CONCLUSION

Based on the current clinical evidence, patients with HAS present distinct clinicopathological features, greater invasiveness, and poorer prognosis than non-HAS patients. Further research is warranted to develop optimal treatment strategies for HAS.

SALL4 in gastrointestinal tract cancers: upstream and downstream regulatory mechanisms

Effective therapeutic targets and early diagnosis are major challenges in the treatment of gastrointestinal tract (GIT) cancers. SALL4 is a well-known transcription factor that is involved in organogenesis during embryonic development. Previous studies have revealed that SALL4 regulates cell proliferation, survival, and migration and maintains stem cell function in mature cells. Additionally, SALL4 overexpression is associated with tumorigenesis. Despite its characterization as a biomarker in various cancers, the role of SALL4 in GIT cancers and the underlying mechanisms are unclear. We describe the functions of SALL4 in GIT cancers and discuss its upstream/downstream genes and pathways associated with each cancer. We also consider the possibility of targeting these genes or pathways as potential therapeutic options for GIT cancers.