血清甲胎蛋白阳性胆囊癌的临床病理特征及预后分析

Clinical features and prognostic analysis of alpha fetoprotein positivegallbladder cancer

目的分析血清甲胎蛋白（AFP）阳性胆囊癌患者的临床特点及预后分析。方法回顾性分析第二军医大学东方肝胆外科医院2003年1月-2013年12月收治的20例血清AFP阳性胆囊癌患者资料（研究组），并以同期收治的140例血清AFP正常胆囊癌作为对照组。对两组胆囊癌患者的临床病理特征和随访资料进行统计学分析。结果研究组与对照组相比，淋巴结转移明显增多（P=0．001），肝侵犯明显增多（P=0．002），手术根治率明显减低（P=0．001）。研究组患者的1年、3年、5年生存率分别为45．0％、20．0％、7．5％，中位生存时间10．93个月。对照组患者的1年、3年、5年生存率分别为68．4％、47．6％、36．2％，中位生存时间为27．06个月。研究组患者的1年、3年、5年生存率以及中位生存时间明显低于对照组患者（P=0．007）。单因素分析显示，术前血清AFP、TNM分期、组织分化、意外胆囊癌、术前黄疸、肝侵犯、手术方式、肿瘤部位与预后有关（P〈0．05）；多因素分析显示：Ⅳ分期（HR：1．566，95％C1：1．090．2．250，P=0．015）、手术方式（HR=1．450，95％CI：1．053～1．997，P：0．023）是胆囊癌患者的独立预后危险因素（P〈0．05）。而术前血清AFP水平并不是影响预后的独立危险因素（P〉0．05）。结论血清AFP阳性胆囊癌更易发生淋巴结转移和肝侵犯，手术根治率降低；但血清AFP水平并不是影响患者预后的独立危险因素。

Objective To analyze clinical features and prognosis factors of alpha fetoprotein（AFP） positive with gallbladder cancer patients. Methods Twenty serum AFP positive patients （ study group ） and one hundred and forty gallbladder cancer cases with normal AFP level （ control group ） who received surgery from January 2003 to December 2013 in the Eastern Hepatobiliary Surgery Hospital were retrospectively reviewed. Their clinicopathologic features and follow-up data were statistically analyzed. Results Compared with the control group, the study group had a higher incidence of lymph node metastasis （ P = 0. 001 ） and liver invasion （ P = 0. 002）. The cure rate of radical operation in the study group was apparently lower than that in the control group（P =0. 001 ）. The 1-, 3-, 5-year survival rate of the study group was 45.0% , 20.0% and 7.5% , respectively,and the median survival was 10.93 months, which was significantly lower than those（68.4% , 47.6% , 36.2% and 27.06 months） of the control group（P = 0. 007 ）. Univariate analysis shows that the AFP level, TNM stage, histological differentiation, incidental gallbladder cancer, preoperative jaundice, liver invasion, operation method and tumor location are risk factors influencing the prognosis of AFP positive gallbladder cancer （ P 〈 0. 05 ）. Cox analysis shows that independent prognostic factors included N stage （HR = 1. 566, 95% CI： 1. 090-2. 250, P = 0. 015 ） , operation method （HR = 1. 450, 95% C1： 1. 053-1. 997, P = 0. 023）, but not AFP level （P 〉 0.05）. Conclusion Gallbladder cancer patients with positive serum AFP usually present more lymph node metastasis and liver invasion, but AFP level is not a independent prognostic factor.