血清AFP阳性胃癌患者的临床病理及预后

Clinicopathological characteristics and prognosis of patients of serum alpha-fetoprotein-producinggastric cancer

目的 探讨血清AFP阳性胃癌患者的临床病理特点及预后.方法 回顾性分析我院2002年7月至2007年7月期间收治的1396例胃癌患者,分析血清AFP与胃癌的临床病理因素、生存率、预后及肝脏转移的关系.结果 本组血清AFP阳性胃癌患者占同期胃癌患者的6.45％（90/1396）.与阴性组相比,AFP阳性组胃癌患者的肿瘤体积更大、更易侵达或侵透浆膜层（82.2％比69.2％）、淋巴结阳性率高（80.0％比60.2％）、临床分期晚、更容易发生肝脏转移（6.67％比1.68％）.血清AFP阳性组患者术后1、3、5年总生存率分别为52.2％、31.1％、20％,无瘤生存率分别为47.8％、24.4％、15.6％.血清AFP阴性组患者术后1、3、5总生存率分别为82.5％、59.9％、48.8％,无瘤生存率分别为77.5％、54.8％、44.3％.血清AFP阳性组发生肝转移后中位生存时间比阴性组更短（5个月比11个月）.结论 血清AFP阳性胃癌恶性程度高,其侵犯深度深、淋巴结转移率高、临床分期晚、容易发生肝转移、生存率低、预后差.

Objective To investigate the clinicopathological characteristics and prognosis of serumb alpha-fetoprotein（AFP）-producing gastric cancer.Methods A total of 1396 cases of gastric cancer in our hospital from 2002 to 2007 were retrospectively reviewed.The relationship between serum AFP with clinicopathological factors,survival rate,prognosis and liver metastasis were analyzed.Results There were 90 AFP-producing gastric cancer patients accounting for 6.45% of all the gastric cancer cases during the time period.In those patients there was bigger tumor size,more T3 and T4 invasion （82.2% vs.69.2%）,higher incidence of lymph node metastasis （80.0% vs.60.2%）and liver metastasis（6.67% vs.1.68%）,and later clinical stage than that in the AFP-negative group.The 1,3,5 year-overall survival （OS） rate in AFP-positive group were 52.2%,31.1%,20% while those in AFP-negative group were 82.5%,59.9%,48.8%.The 1,3,5 year-disease free survival（DFS） rate in AFP-positive group were 47.8%,24.4%,15.6% while those in AFP-negative group were 77.5%,54.8%,44.3%.The AFP-positive group had a shorter median time period than the AFP-negative group when liver metastasis happened （5 months vs.11 months）.Conclusions Serum AFP-producing gastric cancer was higher malignancy,it was deeper in invasion and later in clinical stage,more patients with lymph nodes and liver metastasis,low survival rate and poorer prognosis.