70例血清甲胎蛋白升高晚期胃癌患者的临床病理特征及预后

The prognosis and clinicopathological characteristics of 70 gastric cancer patients with elevated serum AFP

目的探讨血清甲胎蛋白（AFP）升高的晚期胃癌患者的临床病理特征和预后。方法回顾性分析2006年8月至2016年5月经病理确诊的治疗前血清AFP〉20 ng/ml，且接受了至少一线治疗70例晚期胃癌患者的临床病理资料，分析影响AFP升高晚期胃癌患者的预后因素。结果血清AFP≥1 000 ng/ml和血清AFP〈1 000 ng/ml患者的肝转移率分别为78.6%和57.1%，差异无统计学意义（P＝0.064）。一线化疗后AFP下降≥50%和AFP下降〈50%患者的疾病控制率分别为96.3%和56.7%（P＝0.001）；血清AFP下降≥50%患者的总生存时间（OS）为17.2个月，长于化疗后血清AFP下降〈50%的患者（8.8个月），差异有统计学意义（P＝0.007）。70例血清AFP升高胃癌患者的OS为0.5-50.0个月，中位OS为12.8个月。70例患者中，接受单纯化疗31例，接受联合治疗（包括联合靶向治疗、肝介入、放疗和手术等治疗手段）39例。单纯化疗患者的中位OS为11.0个月，联合治疗模式患者的中位OS为15.6个月，差异无统计学意义（P＝0.070）。结论血清AFP升高胃癌是胃癌的一个特殊类型，具有异质性，预后存在差异。血清AFP的下降程度可能为疗效的敏感预测指标，与患者的预后有关。血清AFP升高胃癌的肝转移率显著升高，联合多种治疗模式有可能改善血清AFP升高胃癌患者的预后。

Objective This study aimed to review the clinicopathological characteristics and prognosis of advanced gastric cancer patients with elevated serum Alpha-fetoprotein （ AFP ）. Methods From August 2006 to May 2016,70patients with advanced gastric cancer were enrolled retrospectively. All these patients had pathologically confirmed gastric adenocarcinoma, had a serum AFP level of more than 20 ng/ml, and received at least first-line treatment. The clinicopathological data and follow-up data were collected for analysis. Results Liver metastasis was more common in patients with AFP ≥ 1 000 ng/ml, compared with AFP〈1 000 ng/ml patients （78.6% vs 57.1%, P=0.064）. In patients whose AFP level decreased ≥50% after first-line chemotherapy, the disease control rate and overall survival were both better than those in patients with AFP decreased 〈50%（96.3% vs 56.7%, P=0.001; 17.2 m vs 8.8 m P=0.007）. The overall survival of all these 70 patients ranged from 0.5-50.0 months. 31 patients received chemotherapy only, and 39 patients received combined therapy modality. The overall survival of these two groups were similar（ 11.0 m and 15.6 m, respectively, P = 0.070）. Conclusions Serum AFP-elevated gastric cancer is a special subtype of gastric cancer. It＇s a heterogeneous cancer with different clinical outcomes. The extent of decrease of serum AFP level during follow-up may be a sensitive prognostic and predictive biomarker. Liver metastasis were more common in these patients, and combined treatment may improve survival.