胃肝样腺癌三例报告并文献复习

Hepatoid adenocarcinoma of the stomach： three cases report and review of the literatures

目的 探讨胃肝样腺癌（HAS）的临床病理特点及其诊治,以期指导临床治疗.方法 对华中科技大学同济医学院附属协和医院胃肠外科诊治的3例HAS和2003年至2013年间国内文献报道的94例HAS病例进行汇总分析.结果 97例HAS患者中男性77例,女性20例,年龄33 ～ 84岁,肿瘤原发于胃窦部54例、胃体部12例、胃底贲门部17例、胃体窦部7例、胃底体部5例.患者血清AFP升高者64例,伴淋巴结转移者59例,伴肝转移者54例,伴肺转移者或腹腔转移6例.有效统计本组63例HAS患者的预后,中位生存期为13个月,3年累积生存率为11.1％.结论 胃肝样腺癌是一类特殊而少见类型的胃癌,原发灶多位于胃窦部,血清AFP水平大都升高,易发生肝脏转移及淋巴结转移,预后较差,应予以重视.

Objective To investigate the clinical characteristics,diagnosis and treatment of hepatoid adenocarcinoma of the stomach （HAS） and guide the clinical treatment.Methods Three cases of HAS from the Wuhan Union Hospital and another 94 domestic cases reported from 2003 to 2013 were summarized for analysis.Results In the past ten years,a total of 97 HAS cases were retrieved.There were 77 men and 20 women with ages ranging from 33 to 84 years.Fifty-four cases of tumor located in the antrum,12 cases in the body,17 cases in the fundus and cardia,7 cases in the body and antrum,and 5 cases in the fundus and body.Sixty-four patients had a higher serum AFP level.Fifty-nine patients had lymph node metastases,54 patients had liver metastases,and 6 patients had pulmonary or celiac metastases.After a valid statistical analysis of 63 cases＇ prognosis,the median overall survival time was 13 months and the 3-year survival rate was 11.1％.Conclusion HAS is a special and rare type of gastric carcinoma which has the features of gastric adenocarcinoma.HAS patients are mostly male and most of them are in middle and old age.HAS is mainly located in the antrum.Higher serum AFP level is common in HAS and HAS cases are more inclined to liver and lymph node metastases.Therefore HAS has a poorer prognosis and special attention should be paid to it.