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

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