胃肝样腺癌临床特点及诊治分析

Clinical characteristics, diagnosis and treatment of hepatoid adenocarcinoma of the stomach

目的探讨胃肝样腺癌（HAS）的临床和病理特点及其诊断和治疗。方法回顾性分析201例胃癌中的13例胃肝样腺癌的临床病理特点及其诊断和治疗。结果201例胃癌中检出血清甲胎蛋白（AFP）阳性病例13例（6．5％），其肿瘤组织中的AFP表达均阳性，形态学上癌细胞呈腺样分化结构。癌细胞群呈髓样或条索样排列。AFP阳性胃癌的13例中10例为胃窦癌．且低分化腺癌占10例；胃肝样腺癌肝转移和淋巴结转移发生率较非肝样腺癌组明显高（P〈0．01和P〈0．05）。9例进行根治性胃切除术，4例姑息性胃切除；术后10例接受了规范的辅助化疗。但预后均较差，13例患者存活时间11—55个月。3年生存率23％。结论血清AFP阳性的胃癌有其独特的肿瘤生物学行为，临床治疗效果差．应予以重视。

Objective To investigate the clinical characteristics,diagnosis and treatment of hepatoid adenocarcinoma of the stomach. Methods Clinical data of 13 hepatoid adenocarcinomas of the stomach, collected from 201 cases of gastric cancer, were analyzed retrospectively. Results Of the 201 gastric carcinomas, there were 13 AFP-producing adenocarcinomas of the stomach, the positive rate was 6.5%. Morphologically, the tumor cells formed glandular, medullary and linear structures. Of the 13 hepatoid adenocarcinomas of the stomach, 10 cases were in gastric antrum and 10 cases were poorly differentiated. The metastasis rates of liver and lymph node in hepatoid adenocarcinoma of stomach were higher than those in non-hepatoid adenocarcinoma of stomach. The treatment of hepatoid adenocarcinoma of stomach depended mainly on radical resection, and adjuvant chemotherapy was needed.The prognosis of hepatoid adenocarcinoma of stomach was poor. Conclusion Hepatoid adenocarcinoma of the stomach has its own special tumor biological behavior and poor prognosis. Special attention should be paid to this disease.