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Deng H, Wang L, Li Z, Zhan T, Huang L. Optimal treatment strategies for hepatoid adenocarcinoma of the lung: insights from a comprehensive analysis. BMC Cancer 2024; 24:948. [PMID: 39095810 PMCID: PMC11297620 DOI: 10.1186/s12885-024-12682-z] [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: 04/24/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Hepatoid adenocarcinoma of the lung (HAL) is a distinctly uncommon subtype of lung adenocarcinoma (LAC), characterized by hepatoid features and an alarmingly low 5-year survival rate of approximately 8%. The scarcity of information on this condition has contributed to the absence of standardized treatment protocols, and the molecular underpinnings of its pathogenesis remain largely unexplored. To bridge these gaps, this study compiled data from 191 primary HAL patients to delineate treatment patterns, prognostic factors, and potential pathogenic mechanisms. METHODS This study was divided into two cohorts: cohort 1, comprising 110 patients extracted from the Surveillance, Epidemiology, and End Results (SEER) database, and cohort 2, consisting of 70 patients identified through a comprehensive literature review via the PubMed, Web of Science, and Scopus databases, in addition to 11 patients from Tongji Hospital. The Cox proportional hazards regression model was employed to identify independent prognostic factors. Kaplan-Meier survival curves were generated to assess the impact of treatment modalities centered around surgery and chemotherapy. Moreover, this study evaluated the efficacy of first-line treatment regimens and conducted Gene Ontology function and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses on identified mutated genes. RESULTS The demographic and clinical profile of HAL patients typically comprises older individuals who are smokers, with a predisposition for diagnosis at advanced disease stages, culminating in a high mortality rate. Key prognostic indicators identified included disease stage, chemotherapy and surgical interventions. The study suggests a treatment strategy that advocates chemotherapy for patients with stage IV HAL and surgery for those with non-stage IV disease. The combination of paclitaxel and platinum-based chemotherapy emerged as an efficacious first-line treatment, with the integration of immunotherapy and targeted therapies showing potential benefits. Genetic analysis underscored similarities between HAL and LAC, particularly highlighting aberrant kinase activity (serine, threonine, and tyrosine) and the activation of PI3K-Akt and MAPK signaling pathways as contributing factors to HAL pathogenesis. CONCLUSION Despite its relatively rare occurrence, this study underscores the significance of treatment strategies and concludes probable prognostic factors. Due to limited reports, a deeper understanding of the molecular mechanisms driving tumorigenesis and progression in HAL is needed.
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Affiliation(s)
- Huijing Deng
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Aviation Road, Wuhan, Hubei Province, 430030, China
- The Second Clinical Medical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430000, China
| | - Luyao Wang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Aviation Road, Wuhan, Hubei Province, 430030, China
| | - Zewei Li
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Aviation Road, Wuhan, Hubei Province, 430030, China
- The Second Clinical Medical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430000, China
| | - Tao Zhan
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Aviation Road, Wuhan, Hubei Province, 430030, China
- The Second Clinical Medical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, 430000, China
| | - Liu Huang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Aviation Road, Wuhan, Hubei Province, 430030, China.
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Sun X, Liu J, Hu T, Wu Y, Zhang H. A rare case of hepatoid adenocarcinoma of the lung. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:1368-1371. [PMID: 38071759 PMCID: PMC10730454 DOI: 10.1111/crj.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/12/2023] [Accepted: 11/19/2023] [Indexed: 12/21/2023]
Abstract
Hepatoid adenocarcinoma of the lung is a special type of primary origin in the lung with obvious pathological features and short survival time. However, standard treatment guidelines have not yet been established. Herein, we report a case of hepatoid adenocarcinoma with the primary lesion located in the left upper lung. The tumour size was reduced after four cycles of combined therapy. Subsequent postoperative pathology confirmed complete remission.
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Affiliation(s)
- Xuejian Sun
- The First Clinical Medical College of Lanzhou UniversityLanzhouChina
- Department of Radiologythe First Hospital of Lanzhou UniversityLanzhouChina
| | - Jialin Liu
- The First Clinical Medical College of Lanzhou UniversityLanzhouChina
- Department of Radiologythe First Hospital of Lanzhou UniversityLanzhouChina
| | - Ting Hu
- The First Clinical Medical College of Lanzhou UniversityLanzhouChina
- Department of Radiologythe First Hospital of Lanzhou UniversityLanzhouChina
| | - Yefan Wu
- The First Clinical Medical College of Lanzhou UniversityLanzhouChina
- Department of Radiologythe First Hospital of Lanzhou UniversityLanzhouChina
| | - Hao Zhang
- The First Clinical Medical College of Lanzhou UniversityLanzhouChina
- Department of Radiologythe First Hospital of Lanzhou UniversityLanzhouChina
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Bonis A, Dell’Amore A, Verzeletti V, Melan L, Zambello G, Nardocci C, Comacchio GM, Pezzuto F, Calabrese F, Rea F. Hepatoid Adenocarcinoma of the Lung: A Review of the Most Updated Literature and a Presentation of Three Cases. J Clin Med 2023; 12:jcm12041411. [PMID: 36835946 PMCID: PMC9964907 DOI: 10.3390/jcm12041411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
In a Surgical Thoracic Center, two females and a man were unexpectedly diagnosed with hepatoid adenocarcinoma of the lung (HAL) in a single year. HAL is a rare lung cancer with pathological features of hepatocellular carcinoma with no evidence of liver tumor or other primitive sites of neoplasms. As of today, a comprehensive treatment is still not written. We reviewed the most updated literature on HAL, aiming to highlight the proposed treatments available, and comparing them in terms of survival. General hallmarks of HAL are confirmed: it typically affects middle-aged, heavy-smoker males with a median of 5 cm bulky right upper lobe mass. Overall survival remains poor (13 months), with a longer but non-significant survival in females. Treatments are still unsatisfactory today: surgery guarantees a small benefit compared to non-operated HALs, and only N0 patients demonstrated improved survival (p = 0.04) compared to N1, N2, and N3. Even though the histology is fearsome, these are probably the patients who will benefit from upfront surgery. Chemotherapy seemed to behave as surgery, and there is no statistical difference between chemotherapy only, surgery, or adjuvant treatments, even though adjuvant treatments tend to be more successful. New chemotherapies have been reported with notable results in recent years, such as Tyrosine Kinase Inhibitors and monoclonal antibodies. In this complicated picture, new cases are needed to further build shared evidence in terms of diagnosis, treatments, and survival opportunities.
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Affiliation(s)
- Alessandro Bonis
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health–DSCTV, University of Padova, 35122 Padova, Italy
| | - Andrea Dell’Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health–DSCTV, University of Padova, 35122 Padova, Italy
- Correspondence: ; Tel.: +39-0498-218-740
| | - Vincenzo Verzeletti
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health–DSCTV, University of Padova, 35122 Padova, Italy
| | - Luca Melan
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health–DSCTV, University of Padova, 35122 Padova, Italy
| | - Giovanni Zambello
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health–DSCTV, University of Padova, 35122 Padova, Italy
| | - Chiara Nardocci
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health–DSCTV, University of Padova, 35122 Padova, Italy
| | - Giovanni Maria Comacchio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health–DSCTV, University of Padova, 35122 Padova, Italy
| | - Federica Pezzuto
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health–DSCTV, University of Padova, 35122 Padova, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health–DSCTV, University of Padova, 35122 Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health–DSCTV, University of Padova, 35122 Padova, Italy
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4
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Chen Z, Ding C, Zhang T, He Y, Jiang G. Primary Hepatoid Adenocarcinoma of the Lung: A Systematic Literature Review. Onco Targets Ther 2022; 15:609-627. [PMID: 35676912 PMCID: PMC9167841 DOI: 10.2147/ott.s364465] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/16/2022] [Indexed: 12/15/2022] Open
Abstract
Background Hepatoid adenocarcinoma (HAC) of the lung (HAL) is a rare and aggressive extrahepatic adenocarcinoma with an unknown etiology and unfavorable prognosis, which is similar to the pathophysiological characteristics of hepatocellular carcinoma (HCC). Methods We first presented a 67-year-old patient diagnosed with HAC in the right middle lobe of the lung. Then, a systematic literature search was performed for HAL cases recorded between 1990 and 2020 based on three databases. The clinicopathological features, therapeutic method, and prognosis of this rare disease were reviewed, and corresponding prognostic factors were explored using Kaplan–Meier (K-M) curve and Cox proportional hazards regression model. Additionally, the potential biological mechanisms of HAL were further explored and compared with HCC and lung adenocarcinoma (LUAD) based on online databases. Results In the present study, we reported an HAL patient who underwent surgical resection combined with chemotherapy and succumbed to disease 13 months after surgery. Additionally, a total of 43 experimental studies with 49 HAL patients, including the present case, met the inclusion criteria and were included in the present review. We found that HAL is characterized by a male-dominated incidence and is more common in the right lung. Patients in the surgical subgroup have a better prognosis than those in the non-surgical subgroup (p = 0.034). Moreover, the Cox proportional hazards regression model demonstrated that surgical resection can significantly improve the prognosis of HAL patients (p = 0.016). HAL is a rare disease associated with gene mutations that has a distinctive cause and unique pathogenesis. Additionally, Afatinib and Gefitinib may be new effective agents to better combat HAL. Conclusion In conclusion, males may exhibit an increased risk of developing HAL and poorer prognosis than females. Surgical resection combined with chemotherapy may prolong the survival of patients with HAL. HAL has its unique clinicopathological characteristics and biological mechanisms.
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Affiliation(s)
- Zhitao Chen
- Department of Hepatobiliary Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, People’s Republic of China
| | - Chenchen Ding
- Department of Hepatobiliary Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, People’s Republic of China
| | - Ting Zhang
- Department of Hepatobiliary Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, People’s Republic of China
| | - Yahui He
- Department of Hepatobiliary Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, People’s Republic of China
- School of Medicine, Zhejiang Shuren University, Hangzhou, People’s Republic of China
| | - Guoping Jiang
- Department of Hepatobiliary Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, People’s Republic of China
- Correspondence: Guoping Jiang, Department of Hepatobiliary Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, 848# Dongxin Road, Hangzhou City, Zhejiang Province, People’s Republic of China, Tel +86-0571-87236570, Email
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5
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Li M, Fan Y, Lu H. Hepatoid Adenocarcinoma of the Lung. Technol Cancer Res Treat 2021; 20:15330338211057983. [PMID: 34816785 PMCID: PMC8646196 DOI: 10.1177/15330338211057983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hepatoid adenocarcinoma of the lung (HAL) is an comparatively rare malignant tumor originating from the lung with shorter survival. HAL morphologically and pathologically exhibits hepatocellular carcinoma (HCC)-like characteristics, while its clinical features resemble pulmonary adenocarcinoma. High concentration of alpha-fetoprotein (AFP) is often detected in the serum of HAL patients with no hepatic occupying lesion. Patients with AFP-negative HAL survive a few months longer than those with positive AFP test. HAL is a rare type of carcinoma, so there is a lack of systematic and extensive statistical research. The treatment strategy for HAL is similar to common lung adenocarcinoma. Complete surgical resection and adjuvant chemotherapy are the current major treatments for HAL patients. There are also a few of case reports suggesting that HAL patients may benefit from immunotherapy and targeted therapy. This review focuses on the clinical and pathological features, immunohistochemical staining characteristics, treatment and prognosis of HAL.
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Affiliation(s)
- Meihui Li
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), P.R. China.,Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), P.R. China.,Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, P.R. China.,The First Clinical Medical College, Wenzhou Medical University, Wenzhou, P.R. China
| | - Ying Fan
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), P.R. China.,Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), P.R. China.,Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, P.R. China.,The First Clinical Medical College, Wenzhou Medical University, Wenzhou, P.R. China
| | - Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology on Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), P.R. China.,Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), P.R. China.,Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, P.R. China.,The First Clinical Medical College, Wenzhou Medical University, Wenzhou, P.R. China
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6
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Zhuansun Y, Bian L, Zhao Z, Du Y, Chen R, Lin L, Li J. Clinical characteristics of Hepatoid adenocarcinoma of the lung: Four case reports and literature review. Cancer Treat Res Commun 2021; 29:100474. [PMID: 34656923 DOI: 10.1016/j.ctarc.2021.100474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Hepatoid adenocarcinoma of the lung (HAL) is a rare form of lung cancer, which is characterized by its morphologic hepatoid features. The clinical characteristics and prognosis of this rare form of lung cancer remain obscure. METHODS The clinical courses of four cases of HAL were reported. A literature search was performed up to December 31, 2020, using the electronic databases PubMed and Web of Science. RESULTS Including the present 4 cases, a total of 42 cases of HAL have been reported in the literature. The median age was 58.5 years old (range, 36-73 years). 36 (85.7%) patients were male. 26 (61.9%) patients had a history of smoking, the median amount of smoking was 40 pack years (range, 8-180). The most common site of the primary tumor was the right upper lobe (22 cases, 52.3%) and the left upper lobe (10 cases, 23.8%). 21 patients (50%) had pretreatment serum AFP levels higher than the upper limit, and 4 patients (9.5%) had normal pretreatment serum AFP levels. Treatment of HAL included surgery, chemotherapy, radiotherapy, tyrosine kinase inhibitors (TKIs), anti-angiogenesis therapy, and anti-PD-1/PD-L1 monoclonal antibody. Overall, the prognosis of HAL was poor, with median overall survival (OS) of 14 months. CONCLUSIONS HAL is an aggressive tumor, with a poor prognosis and male predominance, which tends to occur in heavy smokers and affects the right upper lobe of the lung.
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Affiliation(s)
- Yongxun Zhuansun
- Department of Respirology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Lijuan Bian
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zhuxiang Zhao
- Department of Respirology, Guangzhou First People's Hospital, Guangzhou 510180, China
| | - Yumo Du
- Department of Respirology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Rui Chen
- Department of Respirology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Lin Lin
- Department of Respirology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jianguo Li
- Department of Respirology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
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7
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Yang Y, Li Y, Du X. Prognostic Analysis of Gastric Signet Ring Cell Carcinoma and Hepatoid Adenocarcinoma of the Stomach: A Propensity Score-Matched Study. Front Oncol 2021; 11:716962. [PMID: 34458152 PMCID: PMC8385756 DOI: 10.3389/fonc.2021.716962] [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] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/26/2021] [Indexed: 12/19/2022] Open
Abstract
Background Hepatoid adenocarcinoma of the stomach (HAS) is a rare type of primary gastric cancer, and most previous studies have reported that HAS has a poor prognosis due to its aggressive biological behavior. The aim of this study was to compare the prognosis of HAS to that of gastric signet ring cell carcinoma (SRC). Methods This was a single-center, retrospective, observational cohort study (January 2010 to January 2016) of gastric cancer patients with pathological HAS and SRC. Overall survival was compared between HAS and SRC patients. We used univariate Cox regression, multivariate Cox regression, propensity score matching (PSM), inverse probability of treatment weighting, standardized mortality ratio weighting, standardized mortality ratio weighting, and overlap weighting to perform a prognostic analysis. Results A total of 725 (672 SRC and 53 HAS) patients were included. After nearest-neighbor 1:4 PSM, 200 SRC patients and 50 HAS patients were matched. Only in univariate Cox regression analysis with the cohort before PSM did HAS show a significantly worse prognosis than SRC [hazard ratio (HR), 1.66; 95% confidence interval (CI), 1.02-2.69, p = 0.040]. However, in the analysis of multivariate Cox regression with the cohort before PSM and series analysis based on the propensity score, all of the results indicated that there was no statistically significant difference in overall survival between HAS and SRC (all p > 0.05). Furthermore, in the subgroup of proximal location (p = 0.027), T stage 4a & 4b (p = 0.001), N stage 3a & 3b (p = 0.022), with cancer nodules (p = 0.026), serum CEA higher than the normal value (p = 0.038), and serum CA199 higher than the normal value (p = 0.023), the prognosis of HAS was significantly worse than that of SRC. Conclusion Based on our study, there was no statistically significant difference in overall survival between HAS and gastric SRC patients. However, in patients with an advanced tumor stage, HAS may have a worse overall survival than SRC.
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Affiliation(s)
- Yu Yang
- Department of General Surgery, First Medical Center of Chinese People's Liberation Army (PLA), General Hospital, Beijing, China
| | - Yuxuan Li
- Department of General Surgery, First Medical Center of Chinese People's Liberation Army (PLA), General Hospital, Beijing, China
| | - Xiaohui Du
- Department of General Surgery, First Medical Center of Chinese People's Liberation Army (PLA), General Hospital, Beijing, China
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8
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Hou Z, Xie J, Zhang L, Dai G, Chen Y, He L. Hepatoid Adenocarcinoma of the Lung: A Systematic Review of the Literature From 1981 to 2020. Front Oncol 2021; 11:702216. [PMID: 34422656 PMCID: PMC8377348 DOI: 10.3389/fonc.2021.702216] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/20/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives We report the first case of hepatoid adenocarcinoma of the lung (HAL) with PIK3CA mutation. In addition, we analyzed data from HAL cases over the past 40 years to study its main treatment methods, prognosis, and the relationship between prognosis and the serum alpha-fetoprotein (AFP) level before treatment. Methods We report a 66-year-old male case who was diagnosed with locally advanced HAL with PIK3CA mutation and carried out a systematic literature search for HAL cases documented between 1981 and 2020. General patient information including case characteristics was extracted and summarized. The median OS (mOS) of HAL patients was determined using the KM survival curve. The Cox proportional hazards regression model was used to evaluate the effect of tumor size, location, and serum AFP value before treatment and radical surgery (RS) on the prognosis of patients. Results A total of 46 studies including 51 HAL patients was included in our review. Our study revealed that 52.9% of tumors were located in the upper lobe of the right lung. The proportion of serum AFP-positive patients before treatment, early-stage patients (TNM stage I and II), and patients who had received surgery were 69.2%, 34.1%, and 40%, respectively. The mOS of HAL patients was 16.0 months. The 2-year and 5-year survival rates of the patients were 35.3% and 8.0%, respectively. In the subgroup analysis, the 2-year survival rate for patients who received RS was 62.5%, while for patients who were unable to undergo RS, it was only 12.5% (p = 0.009). The Cox proportional hazards regression model indicated that RS can significantly improve the prognosis of HAL patients (p = 0.011), although the location and size of tumor as well as the serum AFP value before treatment had no significant effect on their prognosis (p = 0.82, p = 0.96, p = 0.25). Conclusions HAL patients have a poor prognosis, and the survival benefits for patients receiving chemoradiotherapy or chemotherapy alone appear to be limited. We demonstrate statistically for the first time that pretreatment serum AFP values are not related to the prognosis of HAL patients and RS can significantly improve patient prognosis.
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Affiliation(s)
- Zan Hou
- Department of Oncology, The Affiliated Fifth People's Hospital of Chengdu University of TCM, Chengdu Fifth People's Hospital, Chengdu, China.,Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jiaqing Xie
- Department of Clinical Laboratory, The Affiliated Fifth People's Hospital of Chengdu University of TCM, Chengdu Fifth People's Hospital, Chengdu, China
| | - Li Zhang
- Department of Pathology, The Affiliated Fifth People's Hospital of Chengdu University of TCM, Chengdu Fifth People's Hospital, Chengdu, China
| | - Gangyi Dai
- Department of Oncology, The Affiliated Fifth People's Hospital of Chengdu University of TCM, Chengdu Fifth People's Hospital, Chengdu, China
| | - Yuanhang Chen
- Department of Oncology, The Affiliated Fifth People's Hospital of Chengdu University of TCM, Chengdu Fifth People's Hospital, Chengdu, China
| | - Lang He
- Department of Oncology, The Affiliated Fifth People's Hospital of Chengdu University of TCM, Chengdu Fifth People's Hospital, Chengdu, China
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9
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Xia R, Zhou Y, Wang Y, Yuan J, Ma X. Hepatoid Adenocarcinoma of the Stomach: Current Perspectives and New Developments. Front Oncol 2021; 11:633916. [PMID: 33912455 PMCID: PMC8071951 DOI: 10.3389/fonc.2021.633916] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/09/2021] [Indexed: 02/05/2023] Open
Abstract
Hepatoid adenocarcinoma of the stomach (HAS) is a rare malignant tumor, accounting for only 0.17-15% of gastric cancers. Patients are often diagnosed at an advanced disease stage, and their symptoms are similar to conventional gastric cancer (CGC) without specific clinical manifestation. Morphologically, HAC has identical morphology and immunophenotype compared to hepatocellular carcinoma (HCC). This is considered to be an underestimation in diagnosis due to its rare incidence, and no consensus is reached regarding therapy. HAS generally presents with more aggressive behavior and worse prognosis than CGC. The present review summarizes the current literature and relevant knowledge to elaborate on the epidemic, potential mechanisms, clinical manifestations, diagnosis, management, and prognosis to help clinicians accurately diagnose and treat this malignant tumor.
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Affiliation(s)
- Ruolan Xia
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuwen Zhou
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuqing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiaming Yuan
- West China School of Medicine, Sichuan University, Chengdu, China
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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10
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Wang W, Li G. Radiotherapy of Pulmonary Hepatoid Adenocarcinoma with Intrahepatic Hemangioma: A Case Report. Onco Targets Ther 2020; 13:11947-11955. [PMID: 33239894 PMCID: PMC7682605 DOI: 10.2147/ott.s275340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/23/2020] [Indexed: 12/30/2022] Open
Abstract
Hepatoid adenocarcinoma is defined as an extrahepatic adenocarcinoma with hepatocyte differentiation, characterized by high malignancy and poor prognosis. Herein, we report the diagnosis, treatment and survival of a patient with pulmonary hepatoid adenocarcinoma who had received radiotherapy only. The patient was a 41-year-old man diagnosed with local advanced lung cancer (T3N3M0, stage IIIC). He had an intrahepatic hemangioma and abnormal serum liver enzymes. The patient developed intermittent fever with increased white blood cells and granulocytes during radiotherapy. After 38Gy/19 fractions of radiotherapy, the blood routine results returned to normal levels. After 50Gy/25 fractions of radiotherapy, the patient’s tumor was significantly shrank in imaging. Although the patient refused to receive any treatment after radiotherapy and died 12 months after diagnosis, the data presented here represent a valuable resource for understanding the survival benefits of pulmonary hepatoid adenocarcinoma patients treated with radiotherapy alone.
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Affiliation(s)
- Wenting Wang
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Guang Li
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, People's Republic of China
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11
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Chen L, Han X, Gao Y, Zhao Q, Wang Y, Jiang Y, Liu S, Wu X, Miao L. Anti-PD-1 Therapy Achieved Disease Control After Multiline Chemotherapy in Unresectable KRAS-Positive Hepatoid Lung Adenocarcinoma: A Case Report and Literature Review. Onco Targets Ther 2020; 13:4359-4364. [PMID: 32547068 PMCID: PMC7245476 DOI: 10.2147/ott.s248226] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/28/2020] [Indexed: 12/14/2022] Open
Abstract
Hepatoid adenocarcinoma of the lung (HAL) is extremely rare and standardized treatment strategy for HAL has not been established. Patients with unresectable HAL have a shorter survival time ranges from 1 to 36 months. Here, we reported a 65-year-old female patient with unresectable alpha-fetoprotein-producing HAL harboring KRAS-G12V and no other targetable driver mutations. The patient was treated with multiple lines of chemotherapies followed by PD-1 inhibitor, sintilimab, due to positive staining of PD-L1, and achieved an overall survival of 52 months. Although the disease was under control, the patient experienced fifth-grade pneumonia and died after 6 months of anti-PD-1 treatment. This is the first case of KRAS-positive HAL patient achieved stable disease by PD-1 inhibitor, which may provide valuable information for the treatment strategy development of advanced HAL patients, and highlights the importance of molecular diagnosis in treatment decision-making.
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Affiliation(s)
- Lulu Chen
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Xue Han
- Department of Research and Development, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, People's Republic of China
| | - Yujuan Gao
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Qi Zhao
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Yongsheng Wang
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
| | - Ya Jiang
- Department of Research and Development, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, People's Republic of China
| | - Sisi Liu
- Department of Research and Development, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, People's Republic of China
| | - Xue Wu
- Translational Medicine Research Institute, Geneseeq Technology Inc., Toronto, Ontario, Canada
| | - Liyun Miao
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, People's Republic of China
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WITHDRAWN: Hepatoid adenocarcinoma of the lung accompanied with multiple systemic metastases: An individual case report and literature review. Respir Med Case Rep 2020. [DOI: 10.1016/j.rmcr.2020.101085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Miyama Y, Fujii T, Murase K, Takaya H, Kondo F. Hepatoid adenocarcinoma of the lung mimicking metastatic hepatocellular carcinoma. AUTOPSY AND CASE REPORTS 2020; 10:e2020162. [PMID: 33344280 PMCID: PMC7703083 DOI: 10.4322/acr.2020.162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hepatoid adenocarcinoma of the lung is a rare subtype of lung cancer. We report a case of a metastatic hepatoid adenocarcinoma of the lung with aggressive behavior, including biopsy and autopsy findings. The pulmonary tumors showed features indistinguishable from hepatocellular carcinoma and were diffusely positive for Hepatocyte Paraffin 1.
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Affiliation(s)
- Yu Miyama
- The University of Tokyo, Graduate School of Medicine, Department of Pathology. Tokyo, Japan
| | - Takeshi Fujii
- Toranomon Hospital Kajigaya, Department of Pathology. Kawasaki, Japan
| | - Kyoko Murase
- Toranomon Hospital Kajigaya, Department of Respiratory Medicine. Kawasaki, Japan
| | - Hisashi Takaya
- Toranomon Hospital Kajigaya, Department of Respiratory Medicine. Kawasaki, Japan
| | - Fukuo Kondo
- Teikyo University Hospital, Department of Pathology. Tokyo, Japan
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Tonyali O, Gonullu O, Ozturk MA, Kosif A, Civi OG. Hepatoid adenocarcinoma of the lung and the review of the literature. J Oncol Pharm Pract 2020; 26:1505-1510. [PMID: 32041468 DOI: 10.1177/1078155220903360] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Hepatoid adenocarcinoma of the lung is an extremely rare type of the non-small cell lung cancer. Treatment principles and prognosis are similar to that of lung adenocarcinoma. CASE REPORT A 62-year-old female smoker presented with a huge mass in the left upper lobe. After diagnostic biopsy, she underwent left pneumonectomy and mediastinal lymph node dissection. A diagnosis of stage T4N1M0 hepatoid adenocarcinoma of the lung with positive surgical margins was made. MANAGEMENT AND OUTCOME After the operation, the level of serum alpha fetoprotein was 9010 ng/ml (N: <10). The level of serum alpha fetoprotein was decreased with concurrent chemoradiotherapy and chemotherapy. Disease progression was detected at 11 months after diagnosis. No response was obtained to other therapies. The patient died at 14 months from the time of diagnosis. DISCUSSION Usually, patients with hepatoid adenocarcinoma of the lung are male smokers. Hepatoid adenocarcinoma tends to settle in the upper lobes of the lung. The most important prognostic factor of the hepatoid adenocarcinoma of the lung is the disease stage at the diagnosis and patients with metastatic disease have poor survival.
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Affiliation(s)
- Onder Tonyali
- Department of Medical Oncology, Istanbul Oncology Hospital, Istanbul, Turkey
| | - Onur Gonullu
- Department of Pathology, Agri State Hospital, Agri, Turkey
| | - Mehmet Akif Ozturk
- Department of Medical Oncology, VM Medical Park Pendik, Istanbul, Turkey
| | - Aysun Kosif
- Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozlenen Gonca Civi
- Department of Nuclear Medicine, Istanbul Oncology Hospital, Istanbul, Turkey
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Gastric Hepatoid Adenocarcinoma: Differentiation From Gastric Adenocarcinoma With Dynamic Contrast-Enhanced Computed Tomographic Findings. J Comput Assist Tomogr 2019; 43:887-891. [PMID: 31490893 DOI: 10.1097/rct.0000000000000924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE This study aimed to describe the computed tomographic (CT) findings of gastric hepatoid adenocarcinoma (GHA) and determine features distinguishing it from gastric adenocarcinoma (GA). METHODS Computed tomographic images of pathologically verified GHA (n = 11) and GA (n = 38) were retrospectively reviewed. α-Fetoprotein (AFP), carcinoembryonic antigen (CEA), and CT findings were assessed in our study. Computed tomographic findings included the location, distribution, growth pattern, ulceration, thickness of gastric wall, enhancement pattern, and the ratio of lesion attenuation to aorta CT attenuation. Short diameter of the metastatic lymph nodes, mean short diameter of metastatic lymph nodes, and the ratio of the number of enlarged lymph node on CT to the number of metastatic lymph nodes pathologically were measured and calculated. Data were compared using the χ and Student t tests; significant CT criteria were identified using receiver operating characteristic curve. RESULTS α-Fetoprotein, CEA, and CT findings, including the longest short diameter, the mean short diameter, the ratio of the number of enlarged lymph node on CT to the number of metastatic lymph nodes pathologically, the lesion in arterial phase minus portal venous phase, and the lesion/aorta ratio, were statistically significant predictors for the differentiation of GHA from GA (P < 0.05). When only the aforementioned CT findings were used as criteria, the sensitivity and specificity for diagnosing GHA were 82.86% and 90.91%, respectively. When AFP, CEA, and CT findings were used as criteria, sensitivity of 97.14% and specificity of 90.91% were achieved. CONCLUSIONS Elevated serum AFP level and CT findings could distinguish GHA and GA with a high degree of accuracy.
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Wang C, Xu G, Wu G, Chen Z, Sun Z, Zheng P, Huang Y, Wang F, Yang X. Hepatoid Adenocarcinoma Of The Lung Metastasizing To The Gingiva. Onco Targets Ther 2019; 12:8765-8768. [PMID: 31749622 PMCID: PMC6817769 DOI: 10.2147/ott.s222974] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background Hepatoid adenocarcinoma (HAC) of the lung, a very rare tumor, has been reported metastasizing to lymph nodes and distant tissue, with poor prognosis. We report a case of lung HAC metastasizing to the gingiva, which is a rare metastasis site. Case Report A 70-year-old, 50-pack-year, male smoker was diagnosed with a lung mass on a health examination. A chest CT showed a lung mass in the superior lobe of the right lung and enlarged lymph nodes in the right hilum and mediastinum. Liver and other digestive tumors were excluded. The lung mass was confirmed to be HAC by biopsy with positivity of HepPar-1. Despite erlotinib therapy, the tumor metastasized to the gingiva. Then, docetaxel and nedaplatin therapy, radiotherapy, and bevacizumab therapy were administered successively. The patient died of tumor progression 9 months after presentation. Conclusion Gingival metastasis of lung HAC is rare. The patient had a poor outcome. Further studies need to be conducted on lung HAC.
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Affiliation(s)
- Chunhua Wang
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, Sichuan 610041, People's Republic of China
| | - Guohui Xu
- Department of Interventional Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, Sichuan 610041, People's Republic of China
| | - Ge Wu
- Department of Interventional Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, Sichuan 610041, People's Republic of China
| | - Zhiming Chen
- PET/CT Center, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, People's Republic of China
| | - Zhiyong Sun
- Nuclear Department, The General Hospital of Western Theater Command, Chengdu, Sichuan 610083, People's Republic of China
| | - Ping Zheng
- Department of Pathology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, Sichuan 610041, People's Republic of China
| | - Yecai Huang
- Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, Sichuan 610041, People's Republic of China
| | - Fuqiang Wang
- Department of Interventional Radiology, Linshui County People's Hospital, Guang'an, Sichuan 638500, People's Republic of China
| | - Xuegang Yang
- Department of Interventional Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, Sichuan 610041, People's Republic of China
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Abstract
RATIONALE Hepatoid adenocarcinoma of lung (HAL) is a rare malignant tumor, which can be defined as a primary alpha-fetoprotein (AFP)-producing lung carcinoma. The majority of hepatoid adenocarcinoma (HAC) expressed AFP in tumor cells, but AFP expression is not required for its diagnosis according to the modified diagnostic criteria. Despite that HAC exhibits a poor prognosis and ineffective treatment options, early diagnosis and aggressive treatment can result in long-term survival. PATIENT CONCERNS We report a 70-year-old Chinese male patient with alcoholic intake over 30 years and smoking history of 60 cigarettes per day for 40 years. He sought medical consultation for productive cough and hemoptysis sputum. DIAGNOSES AND INTERVENTIONS Chest CT scan revealed a mass (6.4 × 5.5 cm) in the left lower lobe of the lung. The patient underwent curative surgical resection, and subsequently diagnosed as HAL. OUTCOMES Eighteen months after primary diagnosis, the patient died of multiple organ failure caused by distant metastases. LESSONS Familiarizing with the clinical features and modified diagnostic criteria of this rare tumor may increase awareness of the disease among clinicians and pathologists, thereby avoiding misdiagnosis and mistreatment.
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Affiliation(s)
- Kun Yang
- Central Laboratory, Affiliated Hospital of Qingdao university
| | - Huifeng Jiang
- Department of Pathology, Qilu Hospital, Shandong University, Qingdao, China
| | - Qiuyao Li
- Department of Pathology, Qilu Hospital, Shandong University, Qingdao, China
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