妊娠合并胃癌9例临床特征分析

Analysis of clinicopathological characteristics of 9 cases with gastric cancer during pregnancy

目的探讨妊娠合并胃癌的临床病理特征。方法回顾性分析2010年1月至2020年12月郑州大学第一附属医院收治的9例妊娠合并胃癌病人相关临床病理资料,并对母儿进行短期随访。结果主要症状有恶心呕吐(4例)、上腹痛(2例)、胸闷伴腹胀(2例)。6例CA19-9升高,其中5例同时合并癌胚抗原(CEA)升高。组织学类型以低分化腺癌(5例)和印戒细胞癌(4例)为主。常见转移部位为腹膜(4例)、卵巢(3例)。1例人表皮生长因子受体2(HER2)阳性。仅3例病人接受了根治性切除,术后采用SOX方案(奥沙利铂+替吉奥)化疗,6例晚期病人以奥沙利铂+紫杉醇或SOX方案化疗为主。结论妊娠合并胃癌缺乏特异性临床症状,CEA联合CA19-9可用于辅助晚期胃癌的诊断。制定治疗方案时应综合考虑孕周、肿瘤病理学类型、分期及病人意愿,以争取母儿获益最大化。

Objective To analyze the clinicopathological characteristics of gastric cancer during pregnancy.Methods The clinicopathological data of 9 patients with gastric cancer during pregnancy admitted from January 2010 to December 2020 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively and short-term follow-up of mothers and children was performed.Results The main symptoms were nausea and vomiting(4 cases),epigastric pain(2 cases),and chest tightness/abdominal distension(2 cases).CA19-9 increased in 6 patients,of which 5 patients were accompanied by CEA elevation.The histological types were mainly poorly differentiated adenocarcinoma(5 cases)and signet ring cell carcinoma(4 cases).The most common metastasis sites were peritoneum(4 cases)and ovary(3 cases).One case was HER2 positive.Only three patients underwent radical resection,followed by chemotherapy(SOX:oxaliplatin plus S-1).Six patients with advanced cancer were mainly treated with oxaliplatin plus paclitaxel or SOX.Conclusion Gastric cancer during pregnancy may present without specific clinical symptoms.CEA and CA19-9 can be used to assist the diagnosis of unresectable gastric cancer during pregnancy.The gestational age,pathological type,stage,and patient's wishes should be taken into consideration in planning the treatment modality to maximize the benefits of mother and fetus.