胃肝样腺癌11例分析

Hepatoid adenocarcinoma of stomach:A report of 11 cases

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。方法回顾我院11例胃肝样腺癌的临床病理特点及其诊断和治疗。结果 11例肝样腺癌平均59.27岁,其中男性9例;治疗前血清AFP均升高(5/5);病变均为溃疡或溃疡型肿物、低分化或中低分化腺癌伴部分肝样腺癌,位于胃窦部2例,胃体部3例,贲门部6例;同时有肝转移者5例(5/11);手术切除者7例,其中3例行根治性手术;7例患者均有淋巴结转移;临床病理分期Ⅲ期2例、Ⅳ期9例;5例手术患者、3例未手术患者行不同疗程的全身化疗±介入化疗;患者总体预后差,死亡4例,其生存期为1～10个月。结论胃肝样腺癌是一类特殊的胃癌,容易发生淋巴结、肝脏转移,临床疗效差,应予以重视。

Objective To investigate the clinical characteristics, diagnosis and treatment of hepatoid adenocarcinoma of stomach. Methods Clinical data of 11 hepatoid adenocarcinoma of stomach were analyzed retrospectively. Results The mean age of the 11 cases was 59. 27 years, in which nine cases were male. Serum AFP level elevated in all 5 cases tested before treatment. All tumors presented ulcer lesions, diagnosed as poorly or moderately-poorly differentiated adeno- carcinoma. Tumor located at the gastric antrum in 2 cases, gastric body in 3 cases and cardia in 6 cases. Liver metastases were found in 5 patients. Seven patients received surgery, in which 4 cases had palliative resection, 3 cases had curative resection. Lymph node metastases were found in these 7 patients. Two patients were stage 111, 9 patients were stage IV according to clinicopathologic staging criterion. Five patients with surgery and 3 patients without surgery received chemotherapy with or without interventional therapy. Generally the prognosis of these patients was poor, 4 patients died with OS of 1-10 months. Conclusion Hepatoid adenocarcinoma of stomach is an independent specific entity with poor prognosis. Lymph node metastasis and liver metastasis are common in HAS. Special attention should be paid to HAS.