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Du H, Yang Q, Ge A, Zhao C, Ma Y, Wang S. Explainable machine learning models for early gastric cancer diagnosis. Sci Rep 2024; 14:17457. [PMID: 39075116 PMCID: PMC11286780 DOI: 10.1038/s41598-024-67892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024] Open
Abstract
Gastric cancer remains a significant global health concern, with a notably high incidence in East Asia. This paper explores the potential of explainable machine learning models in enhancing the early diagnosis of gastric cancer. Through comprehensive evaluations, various machine learning models, including WeightedEnsemble, CatBoost, and RandomForest, demonstrated high potential in accurately diagnosing early gastric cancer. The study emphasizes the importance of model explainability in medical diagnostics, showing how transparent, explainable models can increase trust and clinical acceptance, thereby improving diagnostic accuracy and patient outcomes. This research not only highlights key biomarkers and clinical features critical for early detection but also presents a versatile approach that could be applied to other medical diagnostics, promoting broader adoption of machine learning in clinical settings.
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Affiliation(s)
- Hongyang Du
- Heze Administrative Approval Guarantee Center, 3443 Huanghe East Road, Heze City, 274000, Shandong Province, China
| | - Qingfen Yang
- Heze Municipal Hospital, 2888 Caozhou West Road, Heze City, 274031, Shandong Province, China
| | - Aimin Ge
- Heze Municipal Hospital, 2888 Caozhou West Road, Heze City, 274031, Shandong Province, China
| | - Chenhao Zhao
- Heze Municipal Hospital, 2888 Caozhou West Road, Heze City, 274031, Shandong Province, China
| | - Yunhua Ma
- Heze Municipal Hospital, 2888 Caozhou West Road, Heze City, 274031, Shandong Province, China
| | - Shuyu Wang
- Heze Municipal Hospital, 2888 Caozhou West Road, Heze City, 274031, Shandong Province, China.
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Zhang F, Zhang X, Zhang X, Wang Y, Li T, Guo H, Ding P, Tian Y, Yang P, Li X, Meng N, Guo Z, Zhao Q, Zhang R. Recurrent metastatic patterns and prognosis after radical surgery in patients with alpha-fetoprotein-producing gastric cancer: a retrospective cohort study. Am J Cancer Res 2024; 14:2124-2140. [PMID: 38859826 PMCID: PMC11162674 DOI: 10.62347/iiio8739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/24/2024] [Indexed: 06/12/2024] Open
Abstract
Alpha-fetoprotein-producing gastric cancer (AFPGC) is a rare and aggressive subtype of gastric cancer associated with poor prognosis. This study aimed to investigate the recurrent metastatic patterns and prognostic factors in AFPGC patients undergoing radical surgical resection. Data from 241 AFPGC patients diagnosed between January 2017 and January 2020 who underwent surgical resection were analyzed across multiple centers. Recurrence patterns, metastatic sites, and survival outcomes were evaluated. Univariate and multivariate analyses were performed to identify risk factors for recurrent metastasis, overall survival (OS), and disease-free survival (DFS). There is an annual increase in the proportion of AFPGC cases, rising from 3.45% in 2017 to 7.88% in 2023. Higher serum AFP level was associated with increased likelihood of lymph node metastasis (P=0.006), deeper invasion depth (P=0.000) and greater tumor diameter (P=0.036). Independent predictors of recurrent metastasis included T4 infiltration, lymph node metastasis, tumor diameter >5 cm, poorly differentiated-undifferentiated pathology, preoperative AFP>1000 ng/mL, and postoperative increasing trend in AFP levels. The 5-year OS and DFS rates were 36.5% and 34.2%, respectively, with poorer survival linked to higher preoperative AFP levels and postoperative increasing trend in AFP level. Independent risk factors for poor OS and DFS included T4 infiltration, lymph node metastasis, poorly differentiated-undifferentiated pathology, preoperative AFP>1000 ng/mL, and postoperative increasing trend in AFP. Serum AFP level can serve as a potential predictive and prognostic biomarker. Identifying independent risk factors informs risk stratification and personalized treatment for AFPGC patients.
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Affiliation(s)
- Fengbin Zhang
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
| | - Xinran Zhang
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
| | - Xin Zhang
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
| | - Yingnan Wang
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
| | - Tongkun Li
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Honghai Guo
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Ping’an Ding
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Yuan Tian
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Peigang Yang
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Xiaolong Li
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Department of General Surgery, Baoding First Central HospitalBaoding 071000, Hebei, China
| | - Ning Meng
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Department of General Surgery, Shijiazhuang People’s HospitalShijiazhuang 050050, Hebei, China
| | - Zhenjiang Guo
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Department of General Surgery, Hengshui People’s HospitalHengshui 053000, Hebei, China
| | - Qun Zhao
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
- Third Department of Surgery, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
| | - Ruixing Zhang
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011, Hebei, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric CancerShijiazhuang 050011, Hebei, China
- Big Data Analysis and Mining Application for Precise Diagnosis and Treatment of Gastric Cancer, Hebei Provincial Engineering Research CenterShijiazhuang 050011, Hebei, China
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Kimura M, Matsuoka R, Nishikawa K, Imamura J, Kimura K. Alpha-fetoprotein-producing gastric cancer with ruptured liver metastasis mimicking hepatocellular carcinoma. Clin J Gastroenterol 2024; 17:234-239. [PMID: 38214832 DOI: 10.1007/s12328-023-01910-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024]
Abstract
Alpha-fetoprotein (AFP)-producing gastric cancer is a rare subtype of gastric cancer known for its aggressive nature. We present an uncommon case of a 60s male with multiple liver tumors, initially suggested as hepatocellular carcinoma (HCC) by imaging. However, a subsequent gastric biopsy revealed a poorly differentiated adenocarcinoma with hepatoid features, and liver biopsy mirrored these findings. The disease progressed swiftly, with the patient representing owing to the spontaneous rupture of a metastatic liver tumor, an extremely rare occurrence, especially in metastatic liver cancers. Such ruptures in AFP-producing gastric cancer may be attributed to the tumor's rich blood flow. Distinctly differentiating this subtype from HCC is pivotal for apt management, as was evident in our case. The diagnosis was particularly challenging due to the similarities in imaging presentations between AFP-producing gastric cancer liver metastasis and HCC. This case underscores the need for vigilant diagnosis, emphasizing the importance of liver biopsy, especially in the absence of chronic liver disease. It also highlights the potential complications, like spontaneous rupture, associated with this rare form of gastric cancer.
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Affiliation(s)
- Masamichi Kimura
- Department of Hepatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Ryo Matsuoka
- Department of Hepatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Koji Nishikawa
- Department of Hepatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Jun Imamura
- Department of Hepatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kiminori Kimura
- Department of Hepatology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Takayama-Isagawa Y, Kanetaka K, Kobayashi S, Yoneda A, Ito S, Eguchi S. High serum alpha-fetoprotein and positive immunohistochemistry of alpha-fetoprotein are related to poor prognosis of gastric cancer with liver metastasis. Sci Rep 2024; 14:3695. [PMID: 38355790 PMCID: PMC10866906 DOI: 10.1038/s41598-024-54394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/12/2024] [Indexed: 02/16/2024] Open
Abstract
Liver metastasis in gastric cancer is incurable. Alpha-fetoprotein-producing gastric cancer has a poor prognosis and is prone to liver metastasis. We investigated the association between preoperative serum alpha-fetoprotein levels, liver metastasis, and expression of primitive enterocyte phenotype markers. We reviewed the medical records of 401 patients with gastric cancer who underwent curative surgical resection and immunohistochemically evaluated the primitive phenotype markers. The preoperative serum alpha-fetoprotein levels were elevated and normal in 8 and 393 patients, respectively. Liver metastasis was more frequent in patients with higher preoperative alpha-fetoprotein levels. The 5-year postoperative recurrence-free survival and overall survival rates were significantly worse in patients with higher preoperative serum alpha-fetoprotein levels. Although alpha-fetoprotein and Glypican3 and Spalt-like transcription factor 4 tended to be stained with high preoperative serum alpha-fetoprotein levels, these markers were also positive in some patients with normal alpha-fetoprotein levels. In summary, patients with gastric cancer and high preoperative serum alpha-fetoprotein levels have a poor prognosis and high incidence of liver metastasis. Alpha-fetoprotein can help detect liver metastasis relating to the primitive enterocyte phenotype.
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Affiliation(s)
- Yuriko Takayama-Isagawa
- Department of Pathology, Jichi Medical University Hospital, Shimotsuke, Japan
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan
| | - Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan.
| | - Shinichiro Kobayashi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan
| | - Akira Yoneda
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan
| | - Shinichiro Ito
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto 1-7-1, Nagasaki, 8528501, Japan
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Zou J, Shen YK, Wu SN, Wei H, Li QJ, Xu SH, Ling Q, Kang M, Liu ZL, Huang H, Chen X, Wang YX, Liao XL, Tan G, Shao Y. Prediction Model of Ocular Metastases in Gastric Adenocarcinoma: Machine Learning-Based Development and Interpretation Study. Technol Cancer Res Treat 2024; 23:15330338231219352. [PMID: 38233736 PMCID: PMC10865948 DOI: 10.1177/15330338231219352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 10/10/2023] [Accepted: 11/08/2023] [Indexed: 01/19/2024] Open
Abstract
Background: Although gastric adenocarcinoma (GA) related ocular metastasis (OM) is rare, its occurrence indicates a more severe disease. We aimed to utilize machine learning (ML) to analyze the risk factors of GA-related OM and predict its risks. Methods: This is a retrospective cohort study. The clinical data of 3532 GA patients were collected and randomly classified into training and validation sets in a ratio of 7:3. Those with or without OM were classified into OM and non-OM (NOM) groups. Univariate and multivariate logistic regression analyses and least absolute shrinkage and selection operator were conducted. We integrated the variables identified through feature importance ranking and further refined the selection process using forward sequential feature selection based on random forest (RF) algorithm before incorporating them into the ML model. We applied six ML algorithms to construct the predictive GA model. The area under the receiver operating characteristic (ROC) curve indicated the model's predictive ability. Also, we established a network risk calculator based on the best performance model. We used Shapley additive interpretation (SHAP) to identify risk factors and to confirm the interpretability of the black box model. We have de-identified all patient details. Results: The ML model, consisting of 13 variables, achieved an optimal predictive performance using the gradient boosting machine (GBM) model, with an impressive area under the curve (AUC) of 0.997 in the test set. Utilizing the SHAP method, we identified crucial factors for OM in GA patients, including LDL, CA724, CEA, AFP, CA125, Hb, CA153, and Ca2+. Additionally, we validated the model's reliability through an analysis of two patient cases and developed a functional online web prediction calculator based on the GBM model. Conclusion: We used the ML method to establish a risk prediction model for GA-related OM and showed that GBM performed best among the six ML models. The model may identify patients with GA-related OM to provide early and timely treatment.
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Affiliation(s)
- Jie Zou
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, Jiangxi, People's Republic of China
| | - Yan-Kun Shen
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, Jiangxi, People's Republic of China
| | - Shi-Nan Wu
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, Jiangxi, People's Republic of China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, People's Republic of China
| | - Hong Wei
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, Jiangxi, People's Republic of China
| | - Qing-Jian Li
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, People's Republic of China
| | - San Hua Xu
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, Jiangxi, People's Republic of China
| | - Qian Ling
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, Jiangxi, People's Republic of China
| | - Min Kang
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, Jiangxi, People's Republic of China
| | - Zhao-Lin Liu
- Department of Ophthalmology, the First Affiliated Hospital of University of South China, Hunan Branch of National Clinical Research Center for Ocular Disease, Hengyan, Hunan Province, People's Republic of China
| | - Hui Huang
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, Jiangxi, People's Republic of China
| | - Xu Chen
- Department of Ophthalmology and Visual Sciences, Maastricht University, Maastricht, Limburg Province, Netherlands
| | - Yi-Xin Wang
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Xu-Lin Liao
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, People's Republic of China
| | - Gang Tan
- Department of Ophthalmology, the First Affiliated Hospital of University of South China, Hunan Branch of National Clinical Research Center for Ocular Disease, Hengyan, Hunan Province, People's Republic of China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi Branch of National Clinical Research Center for Ocular Disease, Nanchang, Jiangxi, People's Republic of China
- Current affiliation: Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
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Ota T, Sakashita K, Sawada R, Seki K, Maeda H, Tanaka N, Tsujinaka T. Long-term survival with nivolumab followed by irinotecan after total gastrectomy in alpha-fetoprotein-producing gastric cancer: a case report and review of the literature. Surg Case Rep 2023; 9:71. [PMID: 37150760 PMCID: PMC10164665 DOI: 10.1186/s40792-023-01653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/26/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Alpha-fetoprotein-producing gastric cancer (AFPGC) is a rare type of aggressive gastric cancer (GC) with a dismal prognosis. We present a patient with AFPGC who achieved long-term survival through a multidisciplinary approach. CASE PRESENTATION A 67-year-old man with advanced GC was referred to our hospital for systemic chemotherapy. He was diagnosed with cStage IVB AFPGC. During 2nd-line treatment, we could not control bleeding from the GC itself. After complete resection, during chemotherapy, portal venous tumor thrombi (PVTTs) and liver metastases were identified. With nivolumab followed by irinotecan, the PVTTs and liver metastases disappeared. Without immunotherapy and chemotherapy for 23 months, the patient has survived for 48 months so far with no recurrence of GC. CONCLUSION Long-term survival with AFPGC can be accomplished by using several different approaches, such as surgery, immunotherapy, and chemotherapy.
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Affiliation(s)
- Takayo Ota
- Department of Medical Oncology, Izumi City General Hospital, 4-5-1, Wake, Izumi, Osaka, 594-0073, Japan.
| | - Katsuya Sakashita
- Department of Surgery, Izumi City General Hospital, Izumi, Osaka, 594-0073, Japan
| | - Ryugo Sawada
- Department of Surgery, Izumi City General Hospital, Izumi, Osaka, 594-0073, Japan
| | - Kurumi Seki
- Department of Pathology, Izumi City General Hospital, Izumi, Osaka, 594-0073, Japan
| | - Hiroyuki Maeda
- Department of Radiology, Izumi City General Hospital, Izumi, Osaka, 594-0073, Japan
| | - Noriko Tanaka
- Department of Radiology, Izumi City General Hospital, Izumi, Osaka, 594-0073, Japan
| | - Toshimasa Tsujinaka
- Department of Surgery, Izumi City General Hospital, Izumi, Osaka, 594-0073, Japan
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Kamiimabeppu D, Wakatsuki T, Takahari D, Fukuda N, Shimozaki K, Osumi H, Nakayama I, Ogura M, Ooki A, Shinozaki E, Chin K, Yamaguchi K. Treatment efficacy of ramucirumab-containing chemotherapy in patients with alpha-fetoprotein producing gastric cancer. Int J Clin Oncol 2023; 28:121-129. [PMID: 36409433 DOI: 10.1007/s10147-022-02263-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/30/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alpha-Fetoprotein Producing Gastric Cancer (AFPGC) is an aggressive subgroup of gastric cancer. Recently ramucirumab has shown survival benefits in hepatocellular carcinoma, but only in those with higher Alpha-Fetoprotein (AFP) levels. However, the efficacy of ramucirumab-containing chemotherapy in AFPGC remains unclear. METHODS We retrospectively assessed 352 patients who received ramucirumab-containing chemotherapy between June 2015 and December 2019. AFPGC was defined when serum AFP levels were elevated at diagnosis and correlated with the disease state during treatment. Non-AFPGC was defined when serum AFP levels were normal at diagnosis. RESULTS Among the 352 patients, 28 patients were defined as AFPGC and 246 patients were defined as non-AFPGC. AFPGC was characterized by high frequency of liver metastasis and low frequency of peritoneal metastasis compared to non-AFPGC. Ramucirumab containing chemotherapy showed higher response rates in AFPGC (39.1% vs 24.8%, p = 0.198) and disease control rates (86.9% vs 61.5%, p = 0.028) than those of non-AFPGC, respectively. Median progression-free survival (PFS) was 5.5 months (95%CI 3.9-7.1) in AFPGC and 4.0 months (95%CI 3.6-4.6) in non-AFPGC (HR: 0.91, 95% CI 0.61-1.36, p = 0.66), and median overall survival (OS) was 10.7 months (95% CI 7.4-20.8) in AFPGC and 9.2 months (95% CI 8.1-10.4) in non-AFPGC (HR: 0.72, 95% CI 0.48-1.08, p = 0.11), respectively. In multivariate analysis, AFPGC was not a negative prognostic factor both for PFS and OS. CONCLUSION Ramucirumab containing chemotherapy showed higher response and comparable survival in AFPGC compared to those of non-AFPGC. Considering the generally poor prognosis of AFPGC, ramucirumab-containing chemotherapy might be a promising treatment option in AFPGC.
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Affiliation(s)
- Daisaku Kamiimabeppu
- Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan
| | - Takeru Wakatsuki
- Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan.
| | - Daisuke Takahari
- Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan
| | - Naoki Fukuda
- Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan
| | - Keitaro Shimozaki
- Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan
| | - Hiroki Osumi
- Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan
| | - Izuma Nakayama
- Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan
| | - Mariko Ogura
- Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan
| | - Akira Ooki
- Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan
| | - Eiji Shinozaki
- Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan
| | - Keisho Chin
- Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan
| | - Kensei Yamaguchi
- Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan
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Xiang J, Gong W, Wang C, Sun P, Liu A. Complete remission of alpha-fetoprotein-producing gastric cancer by combined tislelizumab-apatinib treatment of a patient with proficient mismatch repair: a case report. World J Surg Oncol 2022; 20:289. [PMID: 36076263 PMCID: PMC9454209 DOI: 10.1186/s12957-022-02751-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alpha‑fetoprotein-producing gastric cancer (AFPGC) is a rare type of gastric cancer with a high rate of metastasis and poor prognosis. Despite substantial progress in the treatment of many solid tumors, there are no reports of the safety and effectiveness of immune checkpoint inhibitors in combination with antiangiogenesis agents for AFPGC patients who have proficient mismatch repair. CASE PRESENTATION We describe a 69-year-old man who was diagnosed with metastatic AFPGC. After progression to chemotherapy resistance, tislelizumab combined with apatinib was administered, although the patient's gastroscopic pathology showed proficient mismatch repair. After three cycles of therapy, partial remission (reduced by 56%) was obtained, and the quality of life improved significantly. Surprisingly, after more than 1 year of continuous application of the combination treatment regimen, both the primary and metastatic tumors in this patient eventually disappeared, which obtained complete remission without surgery. The patient has had a progression-free survival of more than 24 months and is still continuing to benefit. CONCLUSIONS This case is the first example of effective treatment of AFPGC with tislelizumab combined with apatinib. The outcomes of this case suggest a highly effective and tolerable therapeutic strategy for microsatellite-stabilized AFPGC.
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Affiliation(s)
- Jinyu Xiang
- Departments of Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, China
| | - Wenjing Gong
- Departments of Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, China
| | - CongCong Wang
- Departments of Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, China
| | - Ping Sun
- Departments of Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, China
| | - Aina Liu
- Departments of Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, China.
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9
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Ding H, Xu S, Wang K, Wang X, Sun G, Li X, Ran Y, Sun J. Alpha-fetoprotein-producing advanced colorectal cancer: a rare case report and literature review. J Int Med Res 2022; 50:3000605221117218. [PMID: 35999811 PMCID: PMC9421241 DOI: 10.1177/03000605221117218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Alpha-fetoprotein(AFP)-producing colorectal cancer is a rare form of colorectal cancer with a high degree of malignancy, advanced stage, strong invasiveness, poor response to treatment, rapid progression, and poor prognosis. Herein, we present the case of a middle-aged (in his 50s) male patient who underwent left neck lymph node biopsy due to "left neck lymph node enlargement for 5 months." Biopsy results revealed metastatic adenocarcinoma, and computed tomography examination of the chest and abdomen suggested a malignant tumor of the sigmoid colon with multiple metastases. Subsequently, the patient underwent colonoscopy, and the pathological result was colonic adenocarcinoma. Regarding tumor markers, serum alpha-fetoprotein (AFP) was 214 ng/mL. The patient received first- and second-line treatments for colon cancer, but progression-free survival was short. AFP was consistently elevated; after 8 months, the patient had AFP levels of 11,371.8 ng/mL, and imaging confirmed disease progression. The patient subsequently died, with an overall survival of more than 9 months. Compared with other tumor markers, AFP better reflects tumor progression in AFP-producing colorectal cancer.
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Affiliation(s)
- Huan Ding
- Department of Oncology, Zaozhuang Municipal Hospital, Zaozhuang, Shandong Province, China
| | - Shan Xu
- Department of Oncology, Zaozhuang Municipal Hospital, Zaozhuang, Shandong Province, China
| | - Kang Wang
- Department of Oncology, Zaozhuang Municipal Hospital, Zaozhuang, Shandong Province, China
| | - Xin Wang
- Department of Oncology, Zaozhuang Municipal Hospital, Zaozhuang, Shandong Province, China
| | - Guanxing Sun
- Department of Oncology, Zaozhuang Municipal Hospital, Zaozhuang, Shandong Province, China
| | - Xiang Li
- Department of Oncology, Zaozhuang Municipal Hospital, Zaozhuang, Shandong Province, China
| | - Yancui Ran
- Department of Oncology, Zaozhuang Municipal Hospital, Zaozhuang, Shandong Province, China
| | - Jinjun Sun
- Department of Oncology, Zaozhuang Municipal Hospital, Zaozhuang, Shandong Province, China
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10
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Longo R, Carassou P, Leguay C, Basin S, Thiebaut V, Paraschiv EA, Enea AM. A 50-Year-Old Man with Fulminant Alpha-Fetoprotein-Producing Gastric Carcinoma and Disseminated Intravascular Coagulation. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928369. [PMID: 33667215 PMCID: PMC7942205 DOI: 10.12659/ajcr.928369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Male, 50-year-old Final Diagnosis: Disseminated intravascular coagulatio • gastric cancer Symptoms: Paralysis Medication: — Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
- Raffaele Longo
- Division of Medical Oncology, Metz Thionville Regional Hospital, Ars-Laquenexy, France
| | - Philippe Carassou
- Division of Hematology, Metz Thionville Regional Hospital, Ars-Laquenexy, France
| | - Cassandre Leguay
- Division of Medical Oncology, Metz Thionville Regional Hospital, Ars-Laquenexy, France
| | - Sarah Basin
- Division of Medical Oncology, Metz Thionville Regional Hospital, Ars-Laquenexy, France
| | - Victoire Thiebaut
- Division of Medical Oncology, Metz Thionville Regional Hospital, Ars-Laquenexy, France
| | | | - Ana-Maria Enea
- Division of Neurology, Metz Thionville Regional Hospital, Ars-Laquenexy, France
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11
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Li N, Bai C, Zhang R, Ma L, Ren X, Zhang J, Fu Z, Zhao L. Efficacy and safety of apatinib for the treatment of AFP-producing gastric cancer. Transl Oncol 2021; 14:101004. [PMID: 33383486 PMCID: PMC7777135 DOI: 10.1016/j.tranon.2020.101004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Alpha-fetoprotein-producing gastric cancer (AFPGC) poses a therapeutic challenge worldwide because of its poor prognosis. This study aimed to evaluate the efficacy and safety of antiangiogenic drug apatinib in advanced AFPGC in a real-world setting. METHODS From September 2015 to December 2017, twenty-one patients identified with AFPGC from the clinical trial AHEAD-G202, an open-label, prospective, multicenter, non-interventional study of apatinib for advanced metastatic gastric cancer, were enrolled to perform this analysis. Patients received oral apatinib as monotherapy or combination therapy. A treatment cycle was defined as 28 days. The primary outcome was progression-free survival (PFS) and overall survival (OS), and the secondary outcomes included safety, objective response rate (ORR), and disease control rate (DCR). RESULTS Twenty patients were evaluated for the apatinib efficacy analysis. The ORR of apatinib was 10%, whereas the DCR was 70%. The median PFS was 3.5 months [95%confidence interval (CI): 2.34-4.66]. The median OS was 4.5 months (95%CI: 3.49-5.51). Median OS of AFPGC patients without carcinoembryonic antigen (CEA) elevation achieved 30.8 months. CEA elevation was considered to be a potential independent predictive factor for OS (P = 0.030) and PFS (P = 0.047) by the analysis of multivariate analysis. The most common grade 3 to 4 adverse events (AEs) were hypertension (4.8%), hand-foot syndrome (4.8%), anorexia (4.8%), and vomiting and nausea (4.8%). CONCLUSION Apatinib showed promising efficacy and an acceptable safety profile in patients with advanced AFPGC. Antiangiogenic therapy may be a good strategy for the treatment of AFPGC as a rare sub-type of gastric cancer. TRIAL REGISTRATION AHEAD-G202 (NCT02668380).
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Affiliation(s)
- Ningning Li
- Department of Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chunmei Bai
- Department of Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ruixing Zhang
- Department of Gastroenterology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050071, China
| | - Liwen Ma
- Department of Tumor Chemotherapy and Radiology, Peking University Third Hospital, Beijing 100191, China
| | - Xiubao Ren
- Department of Biotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Junping Zhang
- Department of Medical Oncology, Shanxi Academy of Medical Sciences, Shanxi Dayi Hospital, Taiyuan 030032, China
| | - Zhanzhao Fu
- Department of Medical Oncology, First Hospital of Qinhuangdao, Qinhuangdao 066001, China
| | - Lin Zhao
- Department of Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
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12
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Wang R, Li J, Xu D, Li R, Gong P. Dynamic Change in Serum Alpha-fetoprotein Level Predicts Treatment Response and Prognosis of Alpha-fetoprotein-producing Gastric Cancer. Medicine (Baltimore) 2020; 99:e23326. [PMID: 33217870 PMCID: PMC7676545 DOI: 10.1097/md.0000000000023326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/07/2020] [Accepted: 10/21/2020] [Indexed: 01/26/2023] Open
Abstract
Alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) is rare and associated with a suboptimal prognosis. The aim of this retrospective study was to identify prognostic factors, with a particular focus on the dynamics of serum AFP levels during treatment, in AFPGC patients.Data of patients with pathologically diagnosed primary gastric cancer treated with various modalities electronically collected in the medical management systems of 2 hospitals (ie, Shihezi People's Hospital and Shihezi Hospital) in Shihezi city, northwest China, from January 2007 to October 2018 were reviewed. Patients with AFPGC were identified based on serum AFP levels. Associations of the change in serum AFP levels and clinicopathological parameters with treatment response, including the overall response rate and disease control rate, and outcomes, including overall survival (OS) and progression-free survival (PFS), were compared among different groups.Of 2354 patients diagnosed with gastric cancer, 96 patients with AFPGC were identified. The objective response rate and disease control rate were significantly higher in patients whose AFP level decreased by ≥50% than in patients whose AFP level decreased by <50% (68.8% vs. 40.6%, and 87.5% vs. 53.1%, respectively, both P < .05). The median OS and PFS were 32.0 (4-74) and 24.0 (1-66) months, respectively, in patients with a ≥50% decline in AFP, and 12.5 (0-69) and 9.0 (0-63) months, respectively, in those with a <50% decline in AFP (both P < .05). On univariate and multivariate analyses, tumor, node, metastasis staging classification stage, liver metastasis, curable surgery, and the decline in the serum AFP level were associated with OS and PFS.A significant decline in the serum AFP level was associated with good treatment response and prognosis in AFPGC. Along with a decline in the serum AFP level, tumor, node, metastasis staging classification stage, liver metastasis, and curable surgery were also independent factors associated with prognosis.
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Affiliation(s)
- Ruhan Wang
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi City
- Department of Oncology, The Affiliated Hospital of Hubei University of Arts and Sciences, Xiangyang Central Hospital, The People's Republic of China
| | - Jing Li
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi City
| | - Dan Xu
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi City
| | - Ruiyang Li
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi City
| | - Ping Gong
- Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi City
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13
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Meguro S, Suzuki D, Kawai T, Kyokane T, Aoshima Y, Enomoto Y, Yagi H, Kawasaki H, Kosugi I, Tsukui H, Baba S, Iwashita T. A case of an alpha-fetoprotein-producing gastric so-called carcinosarcoma with enteroblastic differentiation. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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14
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Liu D, Li B, Yan B, Liu L, Jia Y, Wang Y, Ma X, Yang F. The clinicopathological features and prognosis of serum AFP positive gastric cancer: a report of 16 cases. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:2439-2446. [PMID: 33042357 PMCID: PMC7539873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
Alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) is a relatively rare type of gastric cancer (GC). To improve the early diagnosis and treatment of AFPGC, we thoroughly investigated the clinicopathological features and prognosis of AFPGC. 139 GC patients who had received treatment from January 2013 to March 2016 in Jinan Central Hospital were included in this study. Blood samples for the pretreatment AFP examinations were collected. The relationship between the serum AFP and the clinicopathological features and prognosis were analyzed. Among the 139 GC cases, 16 cases (11.5%) were AFPGC patients. Compared with the AFP-negative (non-AFPGC) group, the AFPGC patients were prone to have distant metastasis (P=0.029), particularly in the liver, and the abdominal metastasis accounted for 79.4% (27/34). AFPGC patients' cancer is clearly prone to occur in the upper third of the stomach (P=0.008) and among younger (≤60 years old) patients (P=0.044). Furthermore, among the young and middle-aged (≤60 years old) patients, there were no significant differences in the serum carcinoembryonic antigen (CEA), the cancer antigen 19-9 (CA19-9), or the combined (CEA+CA19-9) positive rate between the AFPGC and the non-AFPGC patients. A Kaplan-Meier survival analysis showed that the median overall survival (mOS) of patients with AFPGC was significantly less than it was among the non-AFPGC patients (P=0.042). The serum AFP level (<100 ng/ml vs ≥100 ng/ml) is a prognostic factor for overall survival in AFPGC patients (P=0.041). In conclusion, the real-time examination of serum AFP has great diagnostic and prognostic value for managing AFPGC, especially for young and middle-aged patients.
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Affiliation(s)
- Duanrui Liu
- Research Center of Basic Medicine, Jinan Central Hospital, Cheeloo College of Medicine, Shandong UniversityJinan 250013, People’s Republic of China
| | - Binbin Li
- Research Center of Basic Medicine, Jinan Central Hospital, Cheeloo College of Medicine, Shandong UniversityJinan 250013, People’s Republic of China
- Department of Laboratory Medicine, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong UniversityWeihai 264200, People’s Republic of China
| | - Bing Yan
- Department of General Surgery, Jinan Central Hospital, Cheeloo College of Medicine, Shandong UniversityJinan 250013, People’s Republic of China
| | - Liang Liu
- Department of Gastroenterology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong UniversityJinan 250013, People’s Republic of China
| | - Yanfei Jia
- Research Center of Basic Medicine, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical SciencesJinan 250013, People’s Republic of China
| | - Yunshan Wang
- Research Center of Basic Medicine, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical SciencesJinan 250013, People’s Republic of China
| | - Xiaoli Ma
- Research Center of Basic Medicine, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical SciencesJinan 250013, People’s Republic of China
| | - Fei Yang
- Department of Pathology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong UniversityJinan 250013, People’s Republic of China
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15
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Iwaya M, Riddell R, Asano K, Kobayashi K, Uehara T, Ota H. Alpha-Fetoprotein-Producing Early Gastric Cancer with Intramucosal Hepatoid and Fetal Enteric Differentiation. Case Rep Gastroenterol 2020; 14:426-435. [PMID: 32999644 PMCID: PMC7506198 DOI: 10.1159/000508413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/30/2020] [Indexed: 12/14/2022] Open
Abstract
Alpha-fetoprotein (AFP)-producing gastric carcinomas (AFPGCs) are relatively rare tumors known to have a poor prognosis and commonly found as advanced lesions. Histologically, AFPGCs have been described as having hepatoid and fetal enteric (enteroblastic) morphology and are associated with conventional adenocarcinomas. Prior studies reported a hepatoid component present only in invasive areas and hypothesized that AFPGCs may develop hepatoid features during the process of tumor invasion. We report three cases of AFP-producing early gastric cancer which had an intramucosal hepatoid component. Immunohistochemistry showed that the hepatoid component was diffusely immunoreactive for SALL4, AFP, arginase-1, and HepPar1, and focally for CDX2 and PDX1. An intramucosal transition between the hepatoid component and conventional intramucosal adenocarcinoma was identified. Two patients also had a coexistent fetal enteric component, which was admixed with a hepatoid component. Although at an early stage one patient subsequently developed liver metastasis and a second patient was suspected of having liver metastasis, these were not biopsy-proven. The latter patient had a previous history of hepatocellular carcinoma (HCC) and SALL4 was used on the HCC to distinguish metastatic/further HCC from a gastric metastatic primary with hepatoid differentiation.
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Affiliation(s)
- Mai Iwaya
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Robert Riddell
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Koji Asano
- Department of Pathology, Suwa Central Hospital, Chino, Japan
| | - Kazuo Kobayashi
- Department of Gastroenterology, Kobayashi Hospital, Nagano, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Hiroyoshi Ota
- Department of Clinical Laboratory Sciences, School of Health Sciences, Shinshu University, Matsumoto, Japan
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16
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Gerber TS, Paschold M, Lang H, Roth W, Straub BK. [Variation in morphology or two entities?]. DER PATHOLOGE 2020; 41:70-72. [PMID: 31938820 DOI: 10.1007/s00292-019-00740-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 37-year-old patient presented with B symptoms. On examination, hypodense liver lesions, multiple enlarged and partly confluent lymph nodes in the upper abdomen and retroperitoneum, as well as disseminated splenic and pulmonary foci were detected. Biopsies of a tumor in the coecum and the liver led to the diagnosis of an adenocarcinoma of the colon. In molecular pathology, microsatellite instability was detected. The post-neoadjuvant surgical specimen showed an unusual morphology and the question arose whether a second tumor should be considered.
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Affiliation(s)
- Tiemo S Gerber
- Institut für Pathologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Markus Paschold
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Hauke Lang
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Wilfried Roth
- Institut für Pathologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Beate K Straub
- Institut für Pathologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
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17
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Ren F, Weng W, Zhang Q, Tan C, Xu M, Zhang M, Wang L, Sheng W, Ni S, Huang D. Clinicopathological features and prognosis of AFP-producing colorectal cancer: a single-center analysis of 20 cases. Cancer Manag Res 2019; 11:4557-4567. [PMID: 31191017 PMCID: PMC6529609 DOI: 10.2147/cmar.s196919] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/12/2019] [Indexed: 12/22/2022] Open
Abstract
Background: High serum levels of alpha-fetoprotein (AFP) are observed in some gastrointestinal cancers. However, primary AFP-producing colorectal cancer (CRC) is extremely rare and causes confusion among clinicians. In this study, we analyzed the clinicopathological features and clinical outcomes of AFP-producing CRC and provide a brief view of this rare carcinoma. Patients and methods: Twenty patients with AFP-producing CRC were enrolled at the Fudan University Shanghai Cancer Center from 2012 to 2015. Clinical information, including serum AFP and CEA levels, and outcomes were collected. Tumors were divided into three histologic types: the common adenocarcinoma (COM) type, mucinous adenocarcinoma type and hepatoid type (HPT). Immunohistochemical (IHC) staining of GPC3, Hepa-1, SALL4 and Arg-1 was performed. Additionally, mutations of the KRAS, NRAS and BRAF genes were examined. Finally, another 40 stage-matched patients with traditional CRC were enrolled as controls for survival analysis. Results: AFP-producing CRC was more likely to occur in males (60%) and arose mainly from the ascending (40%) and sigmoid (35%) colon. In addition, the majority of patients with AFP-producing CRC had poor differentiation (50%), advanced local invasion (80%) and lymph node (LN) metastasis (60%). Synchronous distant metastasis was commonly observed (35%). Interestingly, serum AFP levels were closely associated with LN metastasis. Histopathologically, the COM type was the most common pattern. In IHC staining, the HPT pattern was the most distinct due to high positivity rates of GPC3, Hepa-1 and Arg-1. One patient had mismatch repair deficiency, and another had a KRAS mutation. Patients with AFP-producing CRC had worse progression-free and overall survival than patients with traditional CRC. Conclusion: AFP-producing CRC has unique clinical and histopathological characteristics, showing an aggressive biological behavior and worse prognosis than traditional CRC.
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Affiliation(s)
- Fei Ren
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Weiwei Weng
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Qiongyan Zhang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Cong Tan
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Midie Xu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Meng Zhang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Lei Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Weiqi Sheng
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Shujuan Ni
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Dan Huang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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18
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Fluctuations of epigenetic regulations in human gastric Adenocarcinoma: How does it affect? Biomed Pharmacother 2019; 109:144-156. [DOI: 10.1016/j.biopha.2018.10.094] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 12/12/2022] Open
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19
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Xue YZ, Wu TL, Dai YY, Sheng YY, Wu YM, Xia BL, Huang ZW. NEDD9 expression is correlated with epithelial-to-mesenchymal transition markers in colorectal cancer. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:8640-8646. [PMID: 31966721 PMCID: PMC6965374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/26/2017] [Indexed: 06/10/2023]
Abstract
The epithelial-to-mesenchymal transition (EMT) is a critical step in tumor metastasis. NEDD9 has been shown to be an oncogene in colorectal cancer. However, little is known about the relationship between NEDD9 and EMT in colorectal cancer metastasis. A total of 63 pairs of freshly frozen colorectal cancer tissues and adjacent noncancerous tissues were evaluated for NEDD9 gene expression using quantitative real-time PCR. The expression of NEDD9 and three epithelial-mesenchymal transition (EMT)-related proteins (E-cadherin, β-catenin and vimentin) was examined in 122 colorectal cancers by immunohistochemistry. The expression of NEDD9 was markedly increased in colorectal cancer tissues compared with adjacent noncancerous tissues. The expression level of NEDD9 was positively correlated and TNM stage but not with other clinicopathological features of colorectal tumors. Furthermore, the expression of NEDD9 was strongly associated with the loss of epithelial marker E-cadherin and acquired expression of the mesenchymal markers nuclear β-catenin and vimentin. These findings suggested that NEDD9 might promote EMT and the progression of colorectal cancer, and thus may be a potential therapeutic target of colorectal cancers.
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Affiliation(s)
- Yu-Zheng Xue
- Department of Gastroenterology, The Third Hospital Affiliated to Nantong UniversityWuxi, Jiangsu Province, China
| | - Tie-Long Wu
- Department of Gastroenterology, The Third Hospital Affiliated to Nantong UniversityWuxi, Jiangsu Province, China
| | - Yuan-Yuan Dai
- Department of Gastroenterology, The Third Hospital Affiliated to Nantong UniversityWuxi, Jiangsu Province, China
| | - Ying-Yue Sheng
- Department of Gastroenterology, The Third Hospital Affiliated to Nantong UniversityWuxi, Jiangsu Province, China
| | - Yan-Min Wu
- Department of Gastroenterology, The Third Hospital Affiliated to Nantong UniversityWuxi, Jiangsu Province, China
| | - Bei-Lei Xia
- Department of Gastroenterology, The Third Hospital Affiliated to Nantong UniversityWuxi, Jiangsu Province, China
| | - Zhong-Wei Huang
- Department of Emergency, Affiliated Hospital of Nantong UniversityNantong, Jiangsu Province, China
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