Clinicopathological characteristics and prognostic implications of pancreatic neoplasms with elevated alpha-fetoprotein

Objective To analyze the clinicopathological features and prognosis of pancreatic neoplasms with elevated alpha-fetoprotein (AFP). Methods We systematically searched PubMed, Embase, Web of Science, CNKI, and Wanfang databases, identifying 72 case reports encompassing 138 patients with AFP-producing pancreatic tumors. The cohort comprised 91 males and 47 females, with the age of 53.0 (25.0, 64.0) years. In addition, data from 85 patients with pancreatic tumors and normal serum AFP admitted to the First Affiliated Hospital of Xi’an Jiaotong University between May 2015 and May 2024 were retrospectively collected and matched, including 52 males and 33 females, with the age of 59.0 (53.0, 65.0) years. Clinicopathological characteristics and prognosis were compared between the two groups. Results Adenocarcinoma was the most common histology (48/132, 36.4%), and 50% of tumors were located in the pancreatic body/tail (47/94). Immunohistochemistry revealed AFP positivity in 89.3% of cases (75/84). The pretreatment AFP level was 1 500 (253, 8 164) ng/ml, and 75.7% (28/37) had normal carbohydrate antigen 19-9 levels. Post-treatment AFP levels significantly decreased to 18.8 (8.0, 68.5) ng/ml in 33 reported cases. In terms of treatment, 34.7% (34/98) underwent surgery alone, while 37.8% (37/98) received comprehensive therapy. Lymph node metastasis presented in 53.8% (28/52) of patients, and distant metastasis occurred in 68.9% (82/119), with liver metastasis accounting for 93.9% (77/82). The 1-, 3-, and 5-year survival rates for 97 patients were 43.3% (42/97), 18.6% (18/97), 7.2% (7/97), respectively. Compared to the normal AFP group, the AFP-elevated group had a lower 1-year survival rate (27.3% vs 58.8%, P<0.001) and a higher distant metastasis rate (74.1% vs 15.3%, P<0.001). Conclusion Pancreatic tumors with elevated AFP predominantly occurred in middle-aged and elderly males, are mainly pathologically classified as adenocarcinoma, and are more prone to liver metastasis with a potentially poorer prognosis.