伴甲胎蛋白升高胃癌12例临床分析

Clinical Analysis of 12 Cases of Gastric Carcinoma with High Lever of Alpha-fetoprotein

目的探讨伴有甲胎蛋白升高胃癌的临床病理特点及预后。方法 140例胃癌患者中12例伴AFP升高,回顾性分析其临床资料。结果 12例AFP升高胃癌患者甲胎蛋白水平在71.97～275691.6μg/L。病理组织学类型:低分化腺癌58.3%(7/12),管状腺癌25.0%(3/12),肝样腺癌16.7%(2/12)。肿瘤部位以胃窦和胃体多见,占66.7%(8/12),贲门部33.3%(4/12)。临床分期均为Ⅳ期,其中肝门部淋巴结转移16.7%(2/12),肝脏转移25.0%(3/12),腹腔淋巴结转移25.0%(3/12),肝脏转移合并腹腔淋巴结转移25.0%(3/12),其他部位转移8.3%(1/12)。12例胃癌患者中有4例为术后复发和转移,根治术后出现复发和转移的平均时间为7.7个月,最短在根治术后3个月出现转移;6例行姑息手术,2例未行手术治疗。10例患者采用了不同的方案进行姑息化疗。生存期为2～54个月,中位生存期为8个月。结论伴有甲胎蛋白升高的胃癌,是1种特殊的临床亚型,易发生肝脏转移和(或)腹腔淋巴结转移,预后较差。

Objective To explore clinical pathological characteristics and prognosis of gasitric carcinoma（GC） with high lever of alpha-fetoprotein（AFP）.Methods 12 cases of gastric carcinoma patients has high lever of AFP among 140 cases,their clinical data were retrospectively analyzed.Results The alpha-fetoprotein level of 12 cases of gastric carcinoma has high lever of AFP was between 71.97~275691.6 μg/L.Pathological histology：low differentiated adenocarcinoma[58.3%（7/12）],tubular adenocarcinoma[25.0%（3/12）],hepatoid carcinomas[16.7%（2/12）].Tumors were mostly located in the antrum and stomach,which was 66.7%（8/12）,cardiac was 33.3%（4/12）.Clinical staging was for stage IV,and the liver hilar lymph node metastasis was 16.7%（2/12）,liver metastasis was 25.0%（3/12）,abdominal lymph node metastasis was 25.0%（3/12）,liver metastasis with abdominal lymph node metastasis was 25.0%（3/12）,other sites of metastasis was 8.3%（1/12）.4 cases had postoperative recurrence and metastasis,average time of recurrence and metastasis after radical surgery was 7.7 months,the shortest metastasis appeared in 3 months,6 cases received palliative operation,2 cases did not undergo surgery.10 cases adopted different regimens of palliative chemotherapy.Survival period was 2 ~54 months,and the median survival time was 8 months.Conclusion Gasitric carcinoma with high lever of AFP of is a special clinical subtype,it has tendency of liver metastasis and（or） celiac metastasis with poor prognosis.