血清甲胎蛋白阳性胃癌患者的临床病理学特征及预后分析

Clinicopathological characteristics and prognosis analysis of gastric cancer patients with elevated serum alphafetoprotein

背景与目的:血清甲胎蛋白(alpha-fetoprotein,AFP)阳性胃癌是一种临床上比较罕见的胃恶性肿瘤,具有与普通胃癌明显不同的生物学特点,探讨血清AFP阳性胃癌患者的临床病理学特征及影响预后的危险因素。方法:采用回顾性队列研究,分析河北医科大学第四医院外三科2012年1月1日—2015年1月1日行根治性手术治疗的2386例胃癌患者,筛选出术前血清AFP阳性的患者,分析临床病理学特征及影响预后的因素。结果:2386例胃癌患者中术前血清AFP阳性者245例(AFP≥20 ng/mL,10.27%),其余2141例术前血清AFP均为正常(AFP<20 ng/mL,89.73%)。与血清AFP阴性组相比,血清AFP阳性组患者的同时性肝转移率、异时性肝转移率、淋巴结转移率、脉管浸润发生率更高(P均<0.05)。2386例胃癌患者中共有2273例(95.26%)获得完整随访资料,全组患者5年总生存率(overall survival,OS)为49.32%,5年无病生存率(disease-free survival,DFS)为44.61%。其中血清AFP阳性者5年OS和DFS分别为37.50%和34.17%,而血清AFP阴性者5年OS和DFS分别为50.90%和45.84%,两组患者的5年OS和DFS差异均有统计学意义(P均<0.001)。单因素分析显示,术前血清AFP的水平、年龄、病灶部位、肿瘤直径、组织学类型、Borrmann分型、肿瘤浸润深度pT分期、淋巴结转移pN分期、肿瘤pTNM分期、Lauren分型、脉管瘤栓有无、Ki-67阳性比例、术后是否化疗、术后有无肝转移是影响血清AFP阳性胃癌患者预后的危险因素(P均<0.05)。多因素分析发现,血清AFP水平(P=0.001)、肿瘤组织学类型(P=0.002)、肿瘤浸润深度pT分期(P=0.006)、淋巴结转移pN分期(P=0.014)、肿瘤pTNM分期(P=0.001)、脉管瘤栓有无(P=0.024)和术后有无肝转移(P=0.008)是影响其预后的独立危险因素,而术后辅助化疗(P=0.031)是患者预后的保护性因素。结论:AFP阳性胃癌具有易发生肝转移、淋巴结转移且预后差的特点,血清AFP水平是影响其预后的独立危险因素,随着AFP水平的升高,其预后变差。

Background and purpose:Serum alpha-fetoprotein(AFP)positive gastric cancer is a clinically rare gastric malignant tumor with significantly different biological characteristics from ordinary gastric cancer.This study explored clinicopathological characteristics of gastric cancer patients with elevated AFP and risk factors affecting prognosis.Methods:A cohort study was used to retrospectively analyze 2386 gastric cancer patients who underwent radical surgery from Jan.1,2012 to Jan.1,2015 in the Third Department of the Fourth Hospital of Hebei Medical University,and patients with preoperative elevated serum AFP were selected to analyze clinical characteristics and factors affecting prognosis.Results:Among the 2386 gastric cancer patients,245 had positive preoperative serum AFP(AFP≥20 ng/mL,10.27%),and the remaining 2141 patients had normal preoperative serum AFP(AFP<20 ng/mL,89.73%).Compared with negative serum AFP group,patients in positive serum AFP group had higher rates of simultaneous liver metastasis,metachronous liver metastasis,lymph node metastasis and vascular invasion(all P<0.05).Complete follow-up data were obtained from 2273(95.26%)gastric cancer patients.The 5-year overall survival(OS)of the group was 49.32%,and the 5-year disease-free survival(DFS)was 44.61%.Among patients with positive serum AFP,the 5-year OS was 37.50%and the 5-year DFS was 34.17%,while the 5-year OS and DFS of patients with negative serum AFP were 50.90%and 45.84%,respectively.The differences in 5-year OS and DFS between the two groups were statistically significant(all P<0.001).Univariate analysis showed that the preoperative serum AFP expression level,age,lesion site,tumor diameter,histological type,Borrmann classification,tumor invasion depth pT stage,lymph node metastasis pN stage,tumor pTNM stage,Lauren type,presence or absence of vascular tumor thrombus,the proportion of positive Ki67,postoperative chemotherapy and postoperative liver metastasis were risk factors affecting the prognosis of patients with serum AFP positive gastric cancer(all P<0.05).Multivariate analysis found that the level of serum AFP(P=0.001),tumor histology type(P=0.002),tumor infiltration depth pT stage(P=0.006),lymph node metastasis pN stage(P=0.014),tumor pTNM stage(P=0.001),presence or absence of vascular tumor thrombus(P=0.024)and postoperative liver metastasis(P=0.008)were independent risk factors affecting prognosis,and postoperative adjuvant chemotherapy(P=0.031)was a protective factor.Conclusion:AFP positive gastric cancer is prone to liver and lymph node metastases with poor prognosis.The level of serum AFP is an independent risk factor affecting prognosis of the patients.As the level of AFP increases,the prognosis becomes worse.