摘要
目的分析甲胎蛋白阳性胃癌(AFPGC)的临床病理特征及预后。方法回顾性分析1998年1月至2018年12月期间在贵州省人民医院初诊为胃癌的2671例患者,按照纳入和排除标准筛选AFPGC组,得到相同病例数的AFP阴性胃癌组。结果共有98例AFPGC,占同期胃癌的4.5%,以老年男性患者为主,男女比例为2.16∶1,平均年龄为(65±12)岁。与术前相比,多数患者术后血清AFP水平显著下降(中位值:52 ng/ml比5 ng/ml,Z=-2.736,P=0.001)。与AFP阴性胃癌组相比,AFPGC组患者治疗前血清AFP和CEA水平更高(均P<0.05),更易发生脉管浸润(62.71%比40.68%)和肝转移(31.63%比6.12%),均P<0.05。两组患者在肿瘤大小、肿瘤部位、组织分化程度、淋巴结转移等方面差异均无统计学意义(均P>0.05)。AFPGC组患者的预后差于AFP阴性胃癌组患者(P<0.05),单因素生存分析结果显示:AFPGC患者预后与患者术前血清AFP水平、TNM分期、淋巴结转移、同时性肝转移及脉管浸润均有关(均P<0.05);COX多因素生存分析发现术前血清AFP水平是影响患者预后的独立危险因素(P<0.05)。结论AFPGC是一种特殊类型的胃癌,发病率低,易发生脉管浸润和肝转移,预后更差,血清AFP水平是影响AFPGC患者预后的独立危险因素。
Objective To analyze the clinicopathological features and prognostic factors of alpha‐fetoprotein‐producing gastric carcinoma(AFPGC).Methods A retrospective analysis was made on 2671 GC patients admitted from Jan 1998 to Dec 2018,AFPGC patients and matching AFP negative GC cases were enrolled and their clinicopathological features and prognostic factors were analyzed.The survival curve was drawn by Kaplan-Meier method.Log-rank test was used to test the significance,Univariate analysis was performed by using COX proportional hazard model.Results There were 98 AFPGC in this study accounting for 4.5%of all GC of the corresponding time period.The proportion of male to female was 2.16∶1,the average age was(65±12)years.The serum AFP levels significantly decreased after operation in most patients(median:52 ng/ml vs.5 ng/ml,Z=-2.736,P=0.001).Serum AFP and CEA levels in patients with AFPGC before treatment were significantly higher than that in patients with AFP negative GC(both P<0.05).Vascular invasion(62.71%vs.40.68%)and liver metastasis(31.63%vs.6.12%)were more likely to occur in AFPGC groups(both P<0.05).However,there was no significant difference between the two groups in tumor size,location,differentiation and lymph node metastasis(all P>0.05).The prognosis of AFPGC was significant pooer than that in AFP negative GC(P<0.05).Prognosis of AFPGC patients was significantly correlated with preoperative serum AFP level,TNM stage,lymph node metastasis,simultaneous liver metastasis and vascular invasion(all P<0.05).COX multivariate survival analysis found that preoperative serum AFP level was independent risk factors of patients with AFPGC(P<0.05).Conclusion AFPGC is a special GC charactering poor prognosis.
作者
徐开盛
李永柏
黄进堂
王少勇
张忠民
颜艺超
Xu Kaisheng;Li Yongbai;Huang Jintang;Wang Shaoyong;Zhang Zhongmin;Yan Yichao(Department of General Surgery,Guizhou Provincial People's Hospital,Guiyang 550002,China;Department of Gastroenterological Surgery,Peking University International Hospital,Beijing 102206,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2021年第8期585-590,共6页
Chinese Journal of General Surgery
基金
国家自然科学基金青年科学基金项目(81702336)
北京大学国际医院院内科研基金(YN2019XQ01)。
关键词
胃肿瘤
甲胎蛋白类
病理学
临床
预后
Stomach neoplasms
Alpha-fetoproteins
Pathology,clinical
Prognosis
