Assessment of Clinicopathological Characteristics and Development of an Individualized Prognostic Model for Patients With Hepatoid Adenocarcinoma of the Stomach

Key Points Question What are the clinicopathological characteristics and prognoses of patients with hepatoid adenocarcinoma of the stomach (HAS), and what is an accurate and efficient method of predicting overall survival (OS) among these patients? Findings In this prognostic study of 315 patients with HAS, 3 risk factors (perineural invasion, preoperative carcinoembryonic antigen levels ≥5 ng/mL, and pathological node category 3b) were independently associated with worse OS among patients with HAS. Based on these risk factors, a nomogram to predict postoperative OS among patients with HAS was developed. Meaning This study found that, among patients with HAS, perineural invasion, preoperative carcinoembryonic antigen levels, and pathological node category 3b were independently associated with OS; an individualized nomogram that was developed to predict postoperative OS had good prognostic value and may be useful as a supplement to the current tumor-node-metastasis staging system.
Importance Few studies have examined the clinicopathological characteristics and prognoses of patients with hepatoid adenocarcinoma of the stomach (HAS). Objective To explore the clinicopathological characteristics and prognoses of patients with HAS and develop a nomogram to predict overall survival (OS). Design, Setting, and Participants This prognostic study involved a retrospective analysis of data from 315 patients who received a diagnosis of primary HAS between April 1, 2004, and December 31, 2019, at 14 centers in China. Main Outcomes and Measures OS and prognostic factors. Patients were randomly assigned to a derivation cohort (n = 220) and a validation cohort (n = 95). A nomogram was developed based on independent prognostic factors identified through a multivariable Cox mixed-effects model. Results Among 315 patients with HAS (mean [SD] age, 61.9 [10.2] years; 240 men [76.2%]), 137 patients had simple HAS (defined as the presence of histologically contained hepatoid differentiation areas only), and 178 patients had mixed HAS (defined as the presence of hepatoid differentiation areas plus common adenocarcinoma areas). Patients with simple HAS had a higher median preoperative α-fetoprotein level than those with mixed HAS (195.9 ng/mL vs 48.9 ng/mL, respectively; P
This prognostic study examines the clinicopathological characteristics and prognoses of patients with hepatoid adenocarcinoma and develops an individualized nomogram based on independently associated risk factors to predict overall survival among those with this distinct cancer subtype.