Research status of diagnosis and treatment of gastric hepatoid adenocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YU Chengbin , MA Guiliang ,  MAO Weizheng

Department of General Surgery, Qingdao Clinical Medical College, Qingdao Municipal Hospital, Affiliated to Nanjing Medical University, Qingdao, Shandong 266071, P. R. China;

Corresponding author：

MAO Weizheng, Email: greenwood8838@163.com

Keywords：

gastric hepatoid adenocarcinoma; pathological feature; treatment; prognosis

DOI：

10.7507/1007-9424.201907070

Video：

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Objective To understand the research status of diagnosis and treatment of gastric hepatoid adenocarcinoma (GHA) in order to provide a reference for clinical.Method The relevant literatures on diagnosis and treatment of GHA at home and abroad in recent years were searched and reviewed.Results The GHA was a special type of gastric cancer with adenoid and hepatocyte differentiations, and the incidence of GHA in all gastric cancers was less than 1%. The histological morphology of GHA was similar to that of hepatocellular carcinoma, which was often accompanied by elevated serum alpha-fetoprotein and was prone to lymph node and liver metastases. The radical surgery and adjuvant chemotherapy were the most important treatment methods. However, even when the radical resection was performed, the recurrence and metastasis were still common, and there was no standard chemotherapy regimen for GHA at present.Conclusions GHA is a special subtype of gastric cancer with high malignancy, which has rapid clinical progress and poor prognosis. Pathomorphology is the gold standard for the diagnosis of GHA. The therapy of GHA is a comprehensive treatment based on operation and chemotherapy, and gene molecular characteristics and targeted therapy are the research directions in future.

Citation： YU Chengbin, MA Guiliang, MAO Weizheng. Research status of diagnosis and treatment of gastric hepatoid adenocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(4): 515-520. doi: 10.7507/1007-9424.201907070 Copy

1.	Zheng R, Zeng H, Zhang S, et al. Estimates of cancer incidence and mortality in China, 2013. Chin J Cancer, 2017, 36(1): 66.
2.	Zeng XY, Yin YP, Xiao H, et al. Clinicopathological characteristics and prognosis of hepatoid adenocarcinoma of the stomach: Evaluation of a pooled case series. Curr Med Sci, 2018, 38(6): 1054-1061.
3.	Ishikura H, Fukasawa Y, Ogasawara K, et al. An AFP-producing gastric carcinoma with features of hepatic differentiation. A case report. Cancer, 1985, 56(4): 840-848.
4.	Yang J, Wang R, Zhang W, et al. Clinicopathological and prognostic characteristics of hepatoid adenocarcinoma of the stomach. Gastroenterol Res Pract, 2014, 2014: 140587.
5.	Zhao M, Sun L, Lai JZ, et al. Expression of RNA-binding protein LIN28 in classic gastric hepatoid carcinomas, gastric fetal type gastrointestinal adenocarcinomas, and hepatocellular carcinomas: An immunohistochemical study with comparison to SALL4, alpha-fetoprotein, glypican-3, and Hep Par1. Pathol Res Pract, 2018, 214(10): 1707-1712.
6.	Fakhruddin N, Bahmad HF, Aridi T, et al. Hepatoid adenocarcinoma of the stomach: A challenging diagnostic and therapeutic disease through a case report and review of the literature. Front Med (Lausanne), 2017, 4: 164.
7.	Wang Y, Sun L, Li Z, et al. Hepatoid adenocarcinoma of the stomach: a unique subgroup with distinct clinicopathological and molecular features. Gastric Cancer, 2019 Apr 15. doi: 10.1007/s10120-019-00965-5.
8.	Tsuruta S, Ohishi Y, Fujiwara M, et al. Gastric hepatoid adenocarcinomas are a genetically heterogenous group; most tumors show chromosomal instability, but MSI tumors do exist. Hum Pathol, 2019, 88: 27-38.
9.	Xiao C, Wu F, Jiang H, et al. Hepatoid adenocarcinoma of the stomach: Nine case reports and treatment outcomes. Oncol Lett, 2015, 10(3): 1605-1609.
10.	Zhou RU, Cai Y, Yang YI, et al. Hepatoid adenocarcinoma of the stomach: A case report and review of the literature. Oncol Lett, 2015, 9(5): 2126-2128.
11.	Kumashiro Y, Yao T, Aishima S, et al. Hepatoid adenocarcinoma of the stomach: histogenesis and progression in association with intestinal phenotype. Hum Pathol, 2007, 38(6): 857-863.
12.	Baek SK, Han SW, Oh DY, et al. Clinicopathologic characteristics and treatment outcomes of hepatoid adenocarcinoma of the stomach, a rare but unique subtype of gastric cancer. BMC Gastroenterol, 2011, 11: 56.
13.	Inagawa S, Shimazaki J, Hori M, et al. Hepatoid adenocarcinoma of the stomach. Gastric Cancer, 2001, 4(1): 43-52.
14.	Ishikura H, Kirimoto K, Shamoto M, et al. Hepatoid adenocarcinomas of the stomach. An analysis of seven cases. Cancer, 1986, 58(1): 119-126.
15.	Kinjo T, Taniguchi H, Kushima R, et al. Histologic and immunohistochemical analyses of α-fetoprotein-producing cancer of the stomach. Am J Surg Pathol, 2012, 36(1): 56-65.
16.	Su JS, Chen YT, Wang RC, et al. Clinicopathological characteristics in the differential diagnosis of hepatoid adenocarcinoma: a literature review. World J Gastroenterol, 2013, 19(3): 321-327.
17.	Terracciano LM, Glatz K, Mhawech P, et al. Hepatoid adenocarcinoma with liver metastasis mimicking hepatocellular carcinoma: an immunohistochemical and molecular study of eight cases. Am J Surg Pathol, 2003, 27(10): 1302-1312.
18.	Akiyama S, Tamura G, Endoh Y, et al. Histogenesis of hepatoid adenocarcinoma of the stomach: molecular evidence of identical origin with coexistent tubular adenocarcinoma. Int J Cancer, 2003, 106(4): 510-515.
19.	任为正, 苏茂生, 杜晓霞, 等. 胃肝样腺癌 25 例. 中华肝胆外科杂志, 2016, 22(10): 665-667.
20.	Wennerberg AE, Nalesnik MA, Coleman WB. Hepatocyte paraffin 1: a monoclonal antibody that reacts with hepatocytes and can be used for differential diagnosis of hepatic tumors. Am J Pathol, 1993, 143(4): 1050-1054.
21.	Chu PG, Ishizawa S, Wu E, et al. Hepatocyte antigen as a marker of hepatocellular carcinoma: an immunohistochemical comparison to carcinoembryonic antigen, CD10, and alpha-fetoprotein. Am J Surg Pathol, 2002, 26(8): 978-988.
22.	Osada M, Aishima S, Hirahashi M, et al. Combination of hepatocellular markers is useful for prognostication in gastric hepatoid adenocarcinoma. Hum Pathol, 2014, 45(6): 1243-1250.
23.	Zhang J, Tam WL, Tong GQ, et al. Sall4 modulates embryonic stem cell pluripotency and early embryonic development by the transcriptional regulation of Pou5f1. Nat Cell Biol, 2006, 8(10): 1114-1123.
24.	Ushiku T, Shinozaki A, Shibahara J, et al. SALL4 represents fetal gut differentiation of gastric cancer, and is diagnostically useful in distinguishing hepatoid gastric carcinoma from hepatocellular carcinoma. Am J Surg Pathol, 2010, 34(4): 533-540.
25.	McWhorter ES, West RC, Russ JE, et al. LIN28B regulates androgen receptor in human trophoblast cells through Let-7c. Mol Reprod Dev, 2019, 86(9): 1086-1093.
26.	Sentani K, Oue N, Sakamoto N, et al. Gene expression profiling with microarray and SAGE identifies PLUNC as a marker for hepatoid adenocarcinoma of the stomach. Mod Pathol, 2008, 21(4): 464-475.
27.	牟安娜, 王婷. 胃肝样腺癌影像学表现 1 例. 中国医学影像技术, 2019, 35(6): 959.
28.	Lin YY, Chen CM, Huang YH, et al. Liver metastasis from hepatoid adenocarcinoma of the stomach mimicking hepatocellular carcinoma: Dynamic computed tomography findings. World J Gastroenterol, 2015, 21(48): 13524-13531.
29.	Lin CY, Yeh HC, Hsu CM, et al. Clinicopathologial features of gastric hepatoid adenocarcinoma. Biomed J, 2015, 38(1): 65-69.
30.	Søreide JA, Greve OJ, Gudlaugsson E, et al. Hepatoid adenocarcinoma of the stomach-proper identification and treatment remain a challenge. Scand J Gastroenterol, 2016, 51(6): 646-653.
31.	Sano T, Izuishi K, Takebayashi R, et al. Surgical approach for extrahepatic metastasis of HCC in the abdominal cavity. Hepatogastroenterology, 2011, 58(112): 2067-2070.
32.	Lin HJ, Hsieh YH, Fang WL, et al. Clinical manifestations in patients with alpha-fetoprotein-producing gastric cancer. Curr Oncol, 2014, 21(3): e394-e399.
33.	Akazawa Y, Saito T, Hayashi T, et al. Next-generation sequencing analysis for gastric adenocarcinoma with enteroblastic differentiation: emphasis on the relationship with hepatoid adenocarcinoma. Hum Pathol, 2018, 78: 79-88.
34.	Arora K, Bal M, Shih A, et al. Fetal-type gastrointestinal adenocarcinoma: a morphologically distinct entity with unfavourable prognosis. J Clin Pathol, 2018, 71(3): 221-227.
35.	Kwon MJ, Byeon S, Kang SY, et al. Gastric adenocarcinoma with enteroblastic differentiation should be differentiated from hepatoid adenocarcinoma: A study with emphasis on clear cells and clinicopathologic spectrum. Pathol Res Pract, 2019, 215(9): 152525.
36.	Liu X, Sheng W, Wang Y. An analysis of clinicopathological features and prognosis by comparing hepatoid adenocarcinoma of the stomach with AFP-producing gastric cancer. J Surg Oncol, 2012, 106(3): 299-303.
37.	Wang W, Zheng C, Fang C, et al. Time trends of clinicopathological features and surgical treatment for gastric cancer: Results from 2 high-volume institutions in southern China. Surgery, 2015, 158(6): 1590-1597.
38.	苏伟, 张胜龙, 王文涛, 等. 胃肝样腺癌的 MDT 讨论. 中国普外基础与临床杂志, 2018, 25(2): 213-220.
39.	Zeng X, Zhang P, Xiao H, et al. Clinicopathological features and prognosis of intestinal hepatoid adenocarcinoma: evaluation of a pooled case series. Oncotarget, 2017, 9(2): 2715-2725.
40.	Simmet V, Noblecourt M, Lizée T, et al. Chemotherapy of metastatic hepatoid adenocarcinoma: Literature review and two case reports with cisplatin etoposide. Oncol Lett, 2018, 15(1): 48-54.
41.	Kamoshida S, Suzuki M, Sakurai Y, et al. Expression of chemoresistance-related proteins in alpha-fetoprotein-producing adenocarcinoma of the digestive organs. Oncol Rep, 2006, 16(4): 721-727.
42.	Mahajan V, Gupta N, Gupta S, et al. Hepatoid adenocarcinoma of stomach: case report of a rare histological variant. Indian J Pathol Microbiol, 2014, 57(1): 116-119.
43.	Xie Y, Zhao Z, Li P, et al. Hepatoid adenocarcinoma of the stomach is a special and easily misdiagnosed or missed diagnosed subtype of gastric cancer with poor prognosis but curative for patients of pN0/1: the experience of a single center. Int J Clin Exp Med, 2015, 8(5): 6762-6772.
44.	Fujimoto M, Matsuzaki I, Nishino M, et al. HER2 is frequently overexpressed in hepatoid adenocarcinoma and gastric carcinoma with enteroblastic differentiation: a comparison of 35 cases to 334 gastric carcinomas of other histological types. J Clin Pathol, 2018, 71(7): 600-607.
45.	Boland CR. The molecular biology of gastrointestinal cancer: implications for diagnosis and therapy. Gastrointest Endosc Clin N Am, 2008, 18(3): 401-413.
46.	张丽霞, 刘淑贞, 邓新娜, 等. 阿帕替尼治疗胃肝样腺癌 1 例. 医学研究生学报, 2018, 31(4): 416-418.
47.	Fang YU, Wang L, Yang N, et al. Successful multimodal therapy for an α-fetoprotein-producing gastric cancer patient with simultaneous liver metastases. Oncol Lett, 2015, 10(5): 3021-3025.
48.	Vogl TJ, Gruber-Rouh T, Eichler K, et al. Repetitive transarterial chemoembolization (TACE) of liver metastases from gastric cancer: local control and survival results. Eur J Radiol, 2013, 82(2): 258-263.
49.	Liu X, Cheng Y, Sheng W, et al. Analysis of clinicopathologic features and prognostic factors in hepatoid adenocarcinoma of the stomach. Am J Surg Pathol, 2010, 34(10): 1465-1471.
50.	Hirajima S, Komatsu S, Ichikawa D, et al. Liver metastasis is the only independent prognostic factor in AFP-producing gastric cancer. World J Gastroenterol, 2013, 19(36): 6055-6061.
51.	王雅坤, 张小田. 产甲胎蛋白胃癌和胃肝样腺癌. 中华肿瘤杂志, 2017, 39(11): 801-807.
52.	王闫飞, 赖玉梅, 寇芙蓉, 等. 30 例胃肝样腺癌患者临床病理特点及预后分析. 中国肿瘤临床, 2018, 45(7): 355-361.

1. Zheng R, Zeng H, Zhang S, et al. Estimates of cancer incidence and mortality in China, 2013. Chin J Cancer, 2017, 36(1): 66.
2. Zeng XY, Yin YP, Xiao H, et al. Clinicopathological characteristics and prognosis of hepatoid adenocarcinoma of the stomach: Evaluation of a pooled case series. Curr Med Sci, 2018, 38(6): 1054-1061.
3. Ishikura H, Fukasawa Y, Ogasawara K, et al. An AFP-producing gastric carcinoma with features of hepatic differentiation. A case report. Cancer, 1985, 56(4): 840-848.
4. Yang J, Wang R, Zhang W, et al. Clinicopathological and prognostic characteristics of hepatoid adenocarcinoma of the stomach. Gastroenterol Res Pract, 2014, 2014: 140587.
5. Zhao M, Sun L, Lai JZ, et al. Expression of RNA-binding protein LIN28 in classic gastric hepatoid carcinomas, gastric fetal type gastrointestinal adenocarcinomas, and hepatocellular carcinomas: An immunohistochemical study with comparison to SALL4, alpha-fetoprotein, glypican-3, and Hep Par1. Pathol Res Pract, 2018, 214(10): 1707-1712.
6. Fakhruddin N, Bahmad HF, Aridi T, et al. Hepatoid adenocarcinoma of the stomach: A challenging diagnostic and therapeutic disease through a case report and review of the literature. Front Med (Lausanne), 2017, 4: 164.
7. Wang Y, Sun L, Li Z, et al. Hepatoid adenocarcinoma of the stomach: a unique subgroup with distinct clinicopathological and molecular features. Gastric Cancer, 2019 Apr 15. doi: 10.1007/s10120-019-00965-5.
8. Tsuruta S, Ohishi Y, Fujiwara M, et al. Gastric hepatoid adenocarcinomas are a genetically heterogenous group; most tumors show chromosomal instability, but MSI tumors do exist. Hum Pathol, 2019, 88: 27-38.
9. Xiao C, Wu F, Jiang H, et al. Hepatoid adenocarcinoma of the stomach: Nine case reports and treatment outcomes. Oncol Lett, 2015, 10(3): 1605-1609.
10. Zhou RU, Cai Y, Yang YI, et al. Hepatoid adenocarcinoma of the stomach: A case report and review of the literature. Oncol Lett, 2015, 9(5): 2126-2128.
11. Kumashiro Y, Yao T, Aishima S, et al. Hepatoid adenocarcinoma of the stomach: histogenesis and progression in association with intestinal phenotype. Hum Pathol, 2007, 38(6): 857-863.
12. Baek SK, Han SW, Oh DY, et al. Clinicopathologic characteristics and treatment outcomes of hepatoid adenocarcinoma of the stomach, a rare but unique subtype of gastric cancer. BMC Gastroenterol, 2011, 11: 56.
13. Inagawa S, Shimazaki J, Hori M, et al. Hepatoid adenocarcinoma of the stomach. Gastric Cancer, 2001, 4(1): 43-52.
14. Ishikura H, Kirimoto K, Shamoto M, et al. Hepatoid adenocarcinomas of the stomach. An analysis of seven cases. Cancer, 1986, 58(1): 119-126.
15. Kinjo T, Taniguchi H, Kushima R, et al. Histologic and immunohistochemical analyses of α-fetoprotein-producing cancer of the stomach. Am J Surg Pathol, 2012, 36(1): 56-65.
16. Su JS, Chen YT, Wang RC, et al. Clinicopathological characteristics in the differential diagnosis of hepatoid adenocarcinoma: a literature review. World J Gastroenterol, 2013, 19(3): 321-327.
17. Terracciano LM, Glatz K, Mhawech P, et al. Hepatoid adenocarcinoma with liver metastasis mimicking hepatocellular carcinoma: an immunohistochemical and molecular study of eight cases. Am J Surg Pathol, 2003, 27(10): 1302-1312.
18. Akiyama S, Tamura G, Endoh Y, et al. Histogenesis of hepatoid adenocarcinoma of the stomach: molecular evidence of identical origin with coexistent tubular adenocarcinoma. Int J Cancer, 2003, 106(4): 510-515.
19. 任为正, 苏茂生, 杜晓霞, 等. 胃肝样腺癌 25 例. 中华肝胆外科杂志, 2016, 22(10): 665-667.
20. Wennerberg AE, Nalesnik MA, Coleman WB. Hepatocyte paraffin 1: a monoclonal antibody that reacts with hepatocytes and can be used for differential diagnosis of hepatic tumors. Am J Pathol, 1993, 143(4): 1050-1054.
21. Chu PG, Ishizawa S, Wu E, et al. Hepatocyte antigen as a marker of hepatocellular carcinoma: an immunohistochemical comparison to carcinoembryonic antigen, CD10, and alpha-fetoprotein. Am J Surg Pathol, 2002, 26(8): 978-988.
22. Osada M, Aishima S, Hirahashi M, et al. Combination of hepatocellular markers is useful for prognostication in gastric hepatoid adenocarcinoma. Hum Pathol, 2014, 45(6): 1243-1250.
23. Zhang J, Tam WL, Tong GQ, et al. Sall4 modulates embryonic stem cell pluripotency and early embryonic development by the transcriptional regulation of Pou5f1. Nat Cell Biol, 2006, 8(10): 1114-1123.
24. Ushiku T, Shinozaki A, Shibahara J, et al. SALL4 represents fetal gut differentiation of gastric cancer, and is diagnostically useful in distinguishing hepatoid gastric carcinoma from hepatocellular carcinoma. Am J Surg Pathol, 2010, 34(4): 533-540.
25. McWhorter ES, West RC, Russ JE, et al. LIN28B regulates androgen receptor in human trophoblast cells through Let-7c. Mol Reprod Dev, 2019, 86(9): 1086-1093.
26. Sentani K, Oue N, Sakamoto N, et al. Gene expression profiling with microarray and SAGE identifies PLUNC as a marker for hepatoid adenocarcinoma of the stomach. Mod Pathol, 2008, 21(4): 464-475.
27. 牟安娜, 王婷. 胃肝样腺癌影像学表现 1 例. 中国医学影像技术, 2019, 35(6): 959.
28. Lin YY, Chen CM, Huang YH, et al. Liver metastasis from hepatoid adenocarcinoma of the stomach mimicking hepatocellular carcinoma: Dynamic computed tomography findings. World J Gastroenterol, 2015, 21(48): 13524-13531.
29. Lin CY, Yeh HC, Hsu CM, et al. Clinicopathologial features of gastric hepatoid adenocarcinoma. Biomed J, 2015, 38(1): 65-69.
30. Søreide JA, Greve OJ, Gudlaugsson E, et al. Hepatoid adenocarcinoma of the stomach-proper identification and treatment remain a challenge. Scand J Gastroenterol, 2016, 51(6): 646-653.
31. Sano T, Izuishi K, Takebayashi R, et al. Surgical approach for extrahepatic metastasis of HCC in the abdominal cavity. Hepatogastroenterology, 2011, 58(112): 2067-2070.
32. Lin HJ, Hsieh YH, Fang WL, et al. Clinical manifestations in patients with alpha-fetoprotein-producing gastric cancer. Curr Oncol, 2014, 21(3): e394-e399.
33. Akazawa Y, Saito T, Hayashi T, et al. Next-generation sequencing analysis for gastric adenocarcinoma with enteroblastic differentiation: emphasis on the relationship with hepatoid adenocarcinoma. Hum Pathol, 2018, 78: 79-88.
34. Arora K, Bal M, Shih A, et al. Fetal-type gastrointestinal adenocarcinoma: a morphologically distinct entity with unfavourable prognosis. J Clin Pathol, 2018, 71(3): 221-227.
35. Kwon MJ, Byeon S, Kang SY, et al. Gastric adenocarcinoma with enteroblastic differentiation should be differentiated from hepatoid adenocarcinoma: A study with emphasis on clear cells and clinicopathologic spectrum. Pathol Res Pract, 2019, 215(9): 152525.
36. Liu X, Sheng W, Wang Y. An analysis of clinicopathological features and prognosis by comparing hepatoid adenocarcinoma of the stomach with AFP-producing gastric cancer. J Surg Oncol, 2012, 106(3): 299-303.
37. Wang W, Zheng C, Fang C, et al. Time trends of clinicopathological features and surgical treatment for gastric cancer: Results from 2 high-volume institutions in southern China. Surgery, 2015, 158(6): 1590-1597.
38. 苏伟, 张胜龙, 王文涛, 等. 胃肝样腺癌的 MDT 讨论. 中国普外基础与临床杂志, 2018, 25(2): 213-220.
39. Zeng X, Zhang P, Xiao H, et al. Clinicopathological features and prognosis of intestinal hepatoid adenocarcinoma: evaluation of a pooled case series. Oncotarget, 2017, 9(2): 2715-2725.
40. Simmet V, Noblecourt M, Lizée T, et al. Chemotherapy of metastatic hepatoid adenocarcinoma: Literature review and two case reports with cisplatin etoposide. Oncol Lett, 2018, 15(1): 48-54.
41. Kamoshida S, Suzuki M, Sakurai Y, et al. Expression of chemoresistance-related proteins in alpha-fetoprotein-producing adenocarcinoma of the digestive organs. Oncol Rep, 2006, 16(4): 721-727.
42. Mahajan V, Gupta N, Gupta S, et al. Hepatoid adenocarcinoma of stomach: case report of a rare histological variant. Indian J Pathol Microbiol, 2014, 57(1): 116-119.
43. Xie Y, Zhao Z, Li P, et al. Hepatoid adenocarcinoma of the stomach is a special and easily misdiagnosed or missed diagnosed subtype of gastric cancer with poor prognosis but curative for patients of pN0/1: the experience of a single center. Int J Clin Exp Med, 2015, 8(5): 6762-6772.
44. Fujimoto M, Matsuzaki I, Nishino M, et al. HER2 is frequently overexpressed in hepatoid adenocarcinoma and gastric carcinoma with enteroblastic differentiation: a comparison of 35 cases to 334 gastric carcinomas of other histological types. J Clin Pathol, 2018, 71(7): 600-607.
45. Boland CR. The molecular biology of gastrointestinal cancer: implications for diagnosis and therapy. Gastrointest Endosc Clin N Am, 2008, 18(3): 401-413.
46. 张丽霞, 刘淑贞, 邓新娜, 等. 阿帕替尼治疗胃肝样腺癌 1 例. 医学研究生学报, 2018, 31(4): 416-418.
47. Fang YU, Wang L, Yang N, et al. Successful multimodal therapy for an α-fetoprotein-producing gastric cancer patient with simultaneous liver metastases. Oncol Lett, 2015, 10(5): 3021-3025.
48. Vogl TJ, Gruber-Rouh T, Eichler K, et al. Repetitive transarterial chemoembolization (TACE) of liver metastases from gastric cancer: local control and survival results. Eur J Radiol, 2013, 82(2): 258-263.
49. Liu X, Cheng Y, Sheng W, et al. Analysis of clinicopathologic features and prognostic factors in hepatoid adenocarcinoma of the stomach. Am J Surg Pathol, 2010, 34(10): 1465-1471.
50. Hirajima S, Komatsu S, Ichikawa D, et al. Liver metastasis is the only independent prognostic factor in AFP-producing gastric cancer. World J Gastroenterol, 2013, 19(36): 6055-6061.
51. 王雅坤, 张小田. 产甲胎蛋白胃癌和胃肝样腺癌. 中华肿瘤杂志, 2017, 39(11): 801-807.
52. 王闫飞, 赖玉梅, 寇芙蓉, 等. 30 例胃肝样腺癌患者临床病理特点及预后分析. 中国肿瘤临床, 2018, 45(7): 355-361.

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