Clinicopathological Features and Prognosis of Alpha-Fetoprotein-Producing Colorectal Cancer

Alpha-fetoprotein-producing colorectal cancer (AFPCRC) is an exceptionally rare subtype of colorectal cancer. Its clinicopathological features and prognostic implications remain poorly defined.

In this retrospective matched cohort study, 6375 patients who underwent curative resection for colorectal cancer at the China-Japan Union Hospital of Jilin University from January 2020 to December 2024 were screened. A total of 46 patients with AFPCRC (defined by preoperative serum AFP levels > 7.0 ng/mL) were identified. A control group of 92 patients with non-AFPCRC was selected using 1:2 propensity score matching based on age, sex, and TNM stage. Clinicopathological features and survival outcomes were compared between the two groups. Patients with AFPCRC were further stratified into low- and high-AFP subgroups using their median preoperative serum AFP level (8.1 ng/mL) as the cutoff.

Compared with controls, patients with AFPCRC showed significantly higher rates of lymphovascular invasion, the presence of mucinous or signet-ring cell components, and distant metastasis during postoperative follow-up. Disease-free survival (DFS) was significantly shorter in the AFPCRC group than in the control group. TNM stage emerged as an independent predictor of DFS in the overall cohort (p = 0.036). In univariate analysis restricted to AFPCRC patients, preoperative serum AFP level (as a continuous variable) was significantly associated with DFS (p = 0.044).

AFPCRC represents a rare but aggressive subtype of colorectal cancer, characterized by adverse clinicopathological features and a poor prognosis. Preoperative serum AFP level may serve as a useful prognostic biomarker in this patient population.