Prognostic model for patients with hepatoid adenocarcinoma of the stomach

INTRODUCTION: Hepatoid adenocarcinoma of the stomach (HAS) is a rare form of gastric cancer. This study assessed the impact of tumor node metastasis (TNM) stage on survival in HAS compared with non-HAS patients, identified prognostic factors, and developed a predictive nomogram. METHODS: Patients diagnosed with HAS between September 2012 and August 2022 were retrospectively analyzed. Clinical characteristics and survival outcomes were compared between HAS and non-HAS groups before and after TNM stage matching. Prognostic factors were determined using Kaplan-Meier and Cox regression analyses, and nomograms were constructed for survival prediction. RESULTS: Without stage matching, HAS patients showed significantly worse survival than non-HAS patients (HR = 3.09, 95% CI: 2.05-4.67, p < 0.001). After TNM stage matching, no significant difference was observed (HR = 1.14, 95% CI: 0.79-1.64, p = 0.476). The nomogram model incorporating Sal-like protein 4 (SALL4), serum iron (Fe), and free prostate-specific antigen (fPSA) accurately predicted overall survival (AUC = 0.946, 95% CI: 0.897-0.994). CONCLUSIONS: These findings suggest that poorer outcomes in HAS are primarily due to advanced TNM stages, and that SALL4, serum Fe, and fPSA serve as key prognostic indicators.