Clinicopathological features and prognosis of AFP-producing colorectal cancer: a single-center analysis of 20 cases
Clinicopathological features and prognosis of AFP-producing colorectal cancer: a single-center analysis of 20 cases
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产AFP结直肠癌20例临床病理特征及预后分析
DOI：
10.2147/cmar.s196919
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发表时间：
2019-01-01
影响因子：
3.3
通讯作者：
Huang, Dan
中科院分区：
文献类型：
--
作者：
Ren, Fei;Weng, Weiwei;Huang, Dan
背景：某些胃肠癌患者血清甲胎蛋白(AFP)水平较高。然而，产生AFP的原发结直肠癌(CRC)是极其罕见的，并引起临床医生的困惑。在这项研究中，我们分析了产生甲胎蛋白的结直肠癌的临床病理特征和临床转归，并简要介绍了这种罕见的癌。患者和方法：选择2012/2015复旦大学上海肿瘤中心收治的AFP阳性结直肠癌患者20例。收集临床信息，包括血清AFP和CEA水平，以及结果。肿瘤组织学类型分为普通型(COM)、粘液型和肝样型(HPT)。免疫组织化学染色GPC3、HEPA-1、SALL4和Arg-1。此外，还检测了KRAS、NRAS和BRAF基因的突变。最后，另有40例符合分期的传统结直肠癌患者作为对照进行生存分析。结果：AFP阳性结直肠癌多见于男性(60%)，主要发生在升结肠(40%)和乙状结肠(35%)。此外，大多数产生AFP的结直肠癌患者分化差(50%)，局部侵袭晚期(80%)和淋巴结转移(60%)。同步远处转移常见(35%)。有趣的是，血清AFP水平与LN转移密切相关。病理组织学上，COM型是最常见的类型。在免疫组化染色中，由于GPC3、HEPA-1和Arg-1的高阳性率，HPT模式最为明显。一名患者有错配修复缺陷，另一名患者有KRAS突变。产生AFP的结直肠癌患者的无进展和总存活率比传统结直肠癌患者差。结论：产生AFP的结直肠癌具有独特的临床和组织病理学特征，表现出侵袭性的生物学行为，预后较传统结直肠癌差。
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.