中国294例胃肝样腺癌临床数据荟萃分析  

Meta-analysis of 294 cases of gastrohepatoid adenocarcinoma in China

作　　者：王康韬 田梦翔 葛鹤铭 艾则孜•麦麦提 宋堃[1,2] 邓静 陈鸰[1,2] 裴海平[1,2] 谭风波 WANG Kangtao;TIAN Mengxiang;GE Heming;AIZEZI·Maimaiti;SONG Kun;DENG Jing;CHEN Ling;PEI Haiping;TAN Fengbo(Department of General Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;the National Clinical Research Center for Geriatric Disorders(Xiangya Hospital),Changsha 410008,China;Department of Epidemiology and Health Statistics,Xiangya School of Public Health,Central South University,Changsha 410078,China)

机构地区：[1]中南大学湘雅医院普通外科,湖南长沙410008 [2]国家老年疾病临床医学研究中心(湘雅医院),湖南长沙410008 [3]中南大学湘雅公共卫生学院,湖南长沙410078

出　　处：《中国普通外科杂志》2022年第2期242-251,共10页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81702956);湖南省自然科学基金资助项目(2020JJ4903,2020JJ5920);湖南省重点研发计划基金资助项目(2018SK2129)。

摘　　要：背景与目的:胃肝样腺癌(HAS)是一种罕见的特殊类型胃癌,大样本研究极少。本研究检索相关文献报道,通过临床数据荟萃方法分析近年中国HAS现状。方法:检索中英电子期刊数据库,包括万方期刊全文数据库、中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)、Pub Med数据库,筛选并提取中国HAS临床数据进行生存分析。结果:将2014年1月-2021年1月文献报道的总计294例HAS纳入地域分析,发现86.4%的病例主要分布在北京和部分沿海地区。其中有效统计的95例患者中男性77例(81.1%),女性18例(18.9%),年龄跨度为40~79岁。血清AFP升高患者70例(73.7%),其中47例(49.5%)血清AFP>500 ng/mL。确诊时TNM分期为Ⅲ期及Ⅵ期为74例(77.9%),且30例(31.6%)出现肝转移。中位生存期仅11个月,3年累积生存率为12.4%。女性相对男性(HR=2.472, 95%CI=1.247~4.904, P=0.010), AFP>500 ng/mL(HR=1.987,95%CI=1.073~3.677,P=0.029),姑息性手术或未手术患者相对于根治性手术(HR=0.223,95%CI=0.099~0.500,P<0.001)为HAS预后的独立危险因素。结论:中国HAS病例主要分布在北京及部分沿海地区,内陆报道少见。HAS以中老年男性多见,但女性预后更差,血清AFP>500 ng/mL是HAS独立危险因素。HAS诊断时多为晚期,常见肝脏转移,整体预后差,但积极的根治性手术可能带来生存获益。Background and Aims:Hepatoid adenocarcinoma of the stomach(HAS) is a special and rare type of gastric cancer,and there are very few studies on HAS with enough sample size.This study collected the relevant literature reports and analyzed the current status of HAS in China in recent years through a Meta-analysis of clinical data.Methods:Chinese and English electronic journal databases were searched,including Wanfang Journal Full-text Database,China Biomedical Literature Database(CBM),Chinese Science and Technology Journal Database(VIP),Pub Med Database.The clinical data of HAS in China were screened and extracted,and survival analysis were performed.Results:A total of 294 cases of HAS reported in the literature from January 2014 to January 2021 were included in the regional analysis,and it was found that 86.4% of the reported cases were distributed in Beijing and some of the coastal areas.Among the 95 cases with complete data,77 were males(81.1%)and 18 were females(18.9%),with an age span of 40-79 years.There were 70 patients(73.7%) with elevated serum AFP,of whom 47 cases(49.5%) had serum AFP>500 ng/m L.At the time of diagnosis,the TNM stages in 74 case were classified as stage Ⅲ or Ⅵ,and 30(31.6%) of them had liver metastases.The median survival time was only 11 months,and the 3-year cumulative survival rate was12.4%.Women relative to men(HR=2.472,95% CI=1.247-4.904,P=0.010),AFP>500 ng/m L(HR=1.987,95% CI=1.073-3.677,P=0.029),palliative surgery or no versus radical surgery(HR=0.223,95%CI=0.099-0.500,P<0.001) were independent risk factors for the prognosis of HAS.Conclusion:HAS cases in China are mainly reported in Beijing and some of the coastal areas,and are rare in inland regieons.HAS is more common in middle aged and elderly men,but the prognosis in women is worse.Serum AFP>500 ng/m L is an independent risk factor for HAS.HAS is often diagnosed at an advanced stage,liver metastases are common and the overall prognosis is poor,but aggressive radical surgery may yield survival benefits.

关 键 词：胃肿瘤 肝样腺癌 预后 META分析 

分 类 号：R735.2[医药卫生—肿瘤]