483例胃肝样腺癌患者的临床特征及分析

Clinical characteristics and analysis of 483 patients with gastric hepatoid adenocarcinoma

[目的]探讨胃肝样腺癌(hepatoid adenocarcinoma of the stomach, HAS)患者的年龄、性别、血清甲胎蛋白(AFP)水平、免疫组化、肿瘤分期、治疗方案和生存时间之间的关联。[方法]以“肝样腺癌、胃肝样腺癌、诊治、预后”为检索词,检索2011-01-2021-08期间发表于《PubMed》、《万方数据库》、《中国知网》、《中国期刊数据库》的文章;将来自同一中心的某些病例予以合并,信息不全者予以剔除,归纳总结患者发病年龄、性别、临床表现、影像学、组织病理、免疫组化等相关检查以及诊治、随访情况。[结果]共纳入50篇文章,483例患者。HAS主要以上腹部不适、腹胀、反酸、隐痛、黑便、呕血乏力、消瘦等常见症状就诊。HAS好发胃窦(47.6%)、胃体(27.4%)、贲门(18.0%)、胃底(7.0%);66.1%(272/404)的HAS患者血清AFP阳性、74.0%(309/408)患者AFP蛋白阳性、47.8%(107/224)患者Glycipan-3蛋白阳性、50%(112/224)患者hecapocyle蛋白阳性;107例HAS患者术前行胃镜检查,其中95例取检病理初步报告为普通胃腺癌;78.5%患者行根治术治疗、21.5%患者行姑息治疗,50%患者术后化疗;51.5%(225/437)患者死亡,9%患者失访。[结论]HAS患者以上腹部不适为主,大部分患者血清AFP升高且病理组织AFP蛋白阳性,目前首选根治术+术后化疗为主要治疗方案;血清AFP阳性、淋巴结转移、肝转移及术后化疗是影响HAS预后独立危险因素。

[Objective]To retrieval and analyze the clinical features of the literature gastric hepatoid ade-nocarcinoma vasculitis,through which to increase the awareness of the disease and improve clinical diagno-sis and treatment rates.[Methods]With"hepatoid adenocarcinoma,gastric hepatoid adenocarcinoma,diag-nosis and treatment,treatment and prognosis"as the search term,we searched PubMed,Wanfang database,China HowNet and China Journal Database published from January 2011 to August 2021.Some cases from the same center were combined,and the case reports that did not provide the patient's gender,age and treatment plan were excluded.A total of 483 patients were included in 50 articles.The age,gender,clinical manifestation,imaging,histopathology,immunohistochemistry and other relevant examinations,diagnosis,treatment and follow-up of the disease were summarized.[Resuts]A total of 483 cases were included in the study.Gastric hepatoid adenocarcinoma(HAS)was mainly present with abdominal discomfort,abdominal distension,acid reflux,dull pain,black stool,hematemesis,fatigue,weight loss,and high AFP level in physical examination.Serum AFP was positive in 66.1%of patients with gastric hepatoid adenocarcinoma;immunohistochemical AFP was positive in 74.0%(225/437)of patients,immunohistochemical glycan-3 was positive in 52.4%(107/224)of patients,and immunohistochemical hecapocyle was positive in 50%(112/224)of patients;abdominal CT showed gastric thickening in most patients;gastroscopy was performed in 107 patients before operation,of which 95 patients were misdiagnosed as ordinary gastric adenocarcinoma;radical resection was performed in 78.5%of patients,and postoperative chemotherapy was performed in 50%of patients.The patients received palliative treatment;51.5%(225/437)died and 9%lost follow-up.[Conclusion]The patients with HAS mainly suffered from upper abdominal discomfort,most of them had elevated serum AFP and positive immunohistochemical AFP.Radical operation postoperative chemotherapy was the main treatment scheme;Serum AFP positive,lymph node metastasis,liver metastasis and postoperative chemotherapy are independent risk factors for the prognosis.