胃肝样腺癌的临床病理特点及预后分析

Clinicopathological features and prognosis of hepatoid adenocarcinoma of stomach

目的:探讨胃肝样腺癌的临床特征、病理特点及预后分析。方法:回顾性分析山东大学第二医院2010年6月至2020年6月共21例胃肝样腺癌患者临床病理特点、诊断、治疗方法选择及预后。结果:21例患者以男性为主(19例,90.48%),中位年龄67岁;好发于胃窦及胃体为主;病变类型分为浸润型、隆起型、溃疡型,以溃疡型为主(10例,47.62%),伴有远处转移者3例,淋巴结转移者13例,另有4例不易评估;病理类型主要是低分化或中低分化腺癌伴肝样腺癌;治疗前血AFP升高(>20 ng/mL)9例,与组织中AFP表达不完全一致,血AFP表达超过200 ng/mL患者病变组织中均能看到AFP表达;治疗前血CEA升高(>10 ng/mL)3例,在初治后(包括手术和化疗)均能看到AFP及CEA不同程度的下降;根据AJCC第8版肿瘤TNM分期,Ⅰ期3例,Ⅱ期3例,Ⅲ期11例,Ⅳ期4例。Cox回归单因素分析显示是否有远处转移及能否行根治性手术将直接影响患者的总生存期(P<0.05),在临床上手术仍是治疗HAS的首选方式。肿瘤最大直径及肿瘤组织中是否表达AFP也是不良OS的风险因素,但差异无显著差异(P>0.05)。结论:胃癌患者中血AFP升高可能提示胃肝样腺癌的诊断,胃癌患者应常规筛查AFP。肝样腺癌作为特殊类型的胃癌,具有预后差,淋巴结转移及远处转移风险高的特点,手术仍然是治疗的首选方式。

Objective:To investigate the clinical characteristics,pathologic features and prognosis of hepatoid adenocarcinoma of stomach(HAS).Methods:Clinical data of the 21 patients with HAS was analyzed retrospectively.Data included gender,age,level of alpha fetal protein(AFP)and carcinoembryonic antigen(CEA),tumor stage,the maximum diameter of tumor,pathological characteristics,and prognosis of the patients.Results:The patients were composed of 19 males and 2 females with a mean age of 67.0±11.54 years. The most common site of HAS were gastric antrum and gastric body, and the mainly type of HAS was ulcerative type(10 cases, 47.62%). Distant metastasis was found in 3 patients, and lymph node metastasis was found in 13 cases. Low differentiation or medium differentiation adenocarcinoma with hepatoid adenocarcinoma was the common pathological type. The increased level of serum AFP before treatment (AFP>20ng/mL) were found in 9 patients, which were not always consistent with the positive expression of AFP in immunohistochemical stain of tissue. AFP could be expressed positively in the tissues of patients with serum AFP over 200ng/mL. The increased level of serum CEA before treatment(CEA>10ng/mL) were found in 3 patients. Serum AFP and CEA decreased after treatment (including surgery and chemotherapy). According to the TNM staging of AJCC 8th edition, there were 3 cases of stageⅠ, 3 cases of stageⅡ, 11 cases of stageⅢ and 4 cases of stageⅣ. Univariate regression analysis revealed that distant metastasis and the failure of radical surgery were poor prognostic factors(P<0.05). Tumor maximum diameter and the positive expression of AFP in tissue were also related to adverse overall survival(OS), but the differences were not significant(P>0.05). Conclusion: The increased level of serum AFP in patients with gastric carcinoma may indicate the diagnosis of HAS. AFP testing should be recommended in the patients with gastric cancer. HAS, as a special type of gastric cancer, is characterized by poor prognosis and high risk of lymph node metastasis and distant metastasis. Surgery is still the mainly treatment.