We reported a rare case of an AFP-producing carcinoma of the esophagogastric junction, in which long-term survival was achieved through multidisciplinary therapy that included surgery, chemotherapy, and PEIT. AFP-producing carcinoma of the gastrointestinal tract is considered to have a high potential for liver metastasis [
8‐
11]. Carcinoma of the esophagogastric junction, particularly in advanced stages, is also known to have high malignant potential and shows a poor prognosis [
1,
2]. It is notable that long-term survival was achieved in the present case despite the presence of two such unfavorable factors. The outcome suggests that our multidisciplinary approach is a practical option for the treatment tumors with such high malignant potential.
To date, eight cases exhibiting AFP-producing carcinomas of the EGJ have been reported in the literature (Table
1) [
13‐
20]. Five cases were reported from Asia and three were reported from other regions. An association with Barrett’s esophagus was reported in half of the cases [
13,
14,
16,
20], but in others no relationship was found [
15,
17‐
19]. The histological subtypes were as follows: adenocarcinoma (
n = 3) [
16,
17,
19], hepatoid adenocarcinoma (
n = 3) [
14,
15,
18], adenocarcinoma/hepatoid adenocarcinoma (
n = 1) [
20], and mixed-type (
n = 1) [
13]. There were no cases of squamous cell carcinoma. Distant metastasis was frequently detected in cases with high serum levels of AFP at the diagnosis [
14‐
16,
18‐
20]. The serum level of AFP appears to be useful as a marker of metastasis [
17]. With regard to the prognosis, the present case achieved the highest survival term. In the present case, various treatments, including surgery, chemotherapy, and PEIT, were combined according to the patient’s condition because he had various complications, including renal failure and diabetes. PEIT is generally used for the treatment of hepatocellular carcinoma, while it is less commonly used for metastatic lesions from other organs, because most metastatic cases exhibit multiple lesions as well as frequent recurrences. However, the present case achieved the longest known survival period using PEIT, thus suggesting that personalized multidisciplinary therapy, including local treatments, such as PEIT, which are appropriate for the patient’s condition, is essential for the treatment of tumors with such a high malignant potential. The further accumulation of similar cases will be useful for establishing an appropriate therapeutic strategy for AFP-producing carcinomas that develop at the EGJ.
Table 1
The reported cases of AFP-producing adenocarcinoma of the EGJ with distant metastasis
Tanigawa H | 2002 | 44 | F | Hepatoid adenocarcinoma with choriocarcinoma and tubular adenocarcinoma | Normal | + | Liver | Surgery, chemotherapy | Dead (4 months) |
Chiba N | 2005 | 47 | M | Hepatoid adenocarcinoma | 326,400 | + | Liver | Chemotherapy | Dead (14 months) |
Fukuzawa J | 2005 | 55 | M | Hepatoid adenocarcinoma | 47,800 | – | Lung, bone | Surgery, chemotherapy | Dead (9 months) |
Kripp M | 2009 | 76 | M | Adenocarcinoma (por) | 5453 | + | Liver, lymph node | Chemotherapy | Dead (18.5 months) |
Chen YY | 2013 | 45 | M | Adenocarcinoma (tub2) | 171.8 | – | Lymph node | Surgery, chemotherapy | Dead (19 months) |
Nagai Y | 2014 | 62 | M | Hepatoid adenocarcinoma (tub2 > por) | 1473 | – | Liver | Surgery, chemotherapy | Alive (25 months) |
Haussler U | 2016 | 61 | M | Adenocarcinoma (por) | 68,136 | Not described | Liver | Chemotherapy | Alive (9 months) |
Kashani A | 2017 | 83 | M | Adenocarcinoma (tub2) with hepatoid features | > 300,000 | + | Liver, lung, lymph node | – | Dead (2 months) |
Present case | 2017 | 75 | M | Adenocarcinoma (tub2) | 568 | – | Liver, lymph node | Surgery, chemotherapy, PElT | Alive (77 months) |