胃肝样腺癌6例临床资料分析

Clinical data analysis of 6cases with gastric hepatoid adenocarcinoma

[目的]探讨胃肝样腺癌患者的临床表现、治疗以及预后。[方法]回顾性分析6例手术病理证实为胃肝样腺癌患者的临床、病理资料。[结果]6例胃肝样腺癌占医院同期入院胃癌患者的0.4%(6/1 494);1例表现为癌肉瘤,血清甲胎蛋白(AFP)阳性5例,均明显高于正常值上线;3例行根治性手术及化疗,1例行全胃+脾+胰切除及化疗,1例行单纯化疗,1例保守治疗。临床及术后病理提示,6例均有淋巴结转移,其中有2例伴远处转移,术后AFP无明显下降。随访全组患者存活时间2~10个月。[结论]胃肝样腺癌临床表现无明显特异性,病理诊断是其金标准,AFP可用于胃肝样腺癌早期诊断及疗效的判断,部分胃肝样腺癌可以合并肉瘤成分。胃肝样腺癌预后极差,治疗效果欠佳。

[Objective]To investigate the clinical features, treatments,and prognosis of the hepatoid ade- nocarcinoma of stomach（HAS）. [Methods]The pathological and clinical characteristics 6 HAS cases were retrospectively analyzed. All the cases were finally diagnosed as HAS by pathologic examination. [Results] The six HAS cases account for 0. 4 % of all gastric carcinoma patients diagnosed in our unit during the peri- od. In the all six cases,one case was diagnosed as carcinosarcoma by pathology,five cases were AFP posi- tive, and the AFP level was much higher than the UNL. Radical resection and chemotherapy was performed in 3 HAS cases,one case was suffered stomach, spleen and pancreas resection combined with chemothera- py,one case only accepted chemotherapy and 1 case gave up treatments. Lymph node metastasis were diag- nosed in all 6 cases by image or pathology,2 cases accompanied with liver metastasis. The changes of AFP level were negligible after operation. The survival time of all 6 patients was 2-10 months. [Conclusion]HAS is a kind of gastric carcinoma with poor prognosis, which should be diagnosed by pathology. AFP level is useful for HAS diagnosis and treatment. Some cases of HAS may have other phenotype such as carcinosar- coma.