甲胎蛋白升高型胃癌的临床病理特征及预后分析  

Clinicopathological features and prognostic analysis of alpha-fetoprotein-producing gastric cancer

作　　者：王晓辉[1] 张威[1] 郭玉霖 张逸飞 高崇崇[1] 张钰鹏[1] 曹锋[1] 李昂[1] 李非[1] Wang Xiaohui;Zhang Wei;Guo Yulin;Zhang Yifei;Gao Chongchong;Zhang Yupeng;Cao Feng;Li Ang;Li Fei(Department of General Surgery,Xuanwu Hospital of Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院普通外科,北京100053

出　　处：《中国医刊》2023年第1期63-66,共4页Chinese Journal of Medicine

基　　金：首都医科大学学生科研训练项目(XSKY2022223)。

摘　　要：目的分析甲胎蛋白升高型胃癌(alpha-fetoprotein-producing gastric cancer,AFPGC)患者的临床病理特征和预后影响因素。方法回顾性分析2004年1月至2020年2月首都医科大学宣武医院收治的进行D2根治性手术治疗的531例胃癌患者的临床资料,选取所有AFPGC患者[甲胎蛋白(alpha fetoprotein,AFP)>30μg/L]为AFP升高胃癌组(22例),根据匹配原则另择同期首都医科大学宣武医院收治的22例AFP水平正常的胃癌患者为AFP正常胃癌组。比较分析两组患者的临床病理特征以及术后5年总生存率。分析影响AFPGC患者术后5年总生存率的独立危险因素。结果本研究中,AFPGC的比例为4.14%(22/531)。两组患者的肿瘤大小、肿瘤部位、肿瘤分化程度、肿瘤浸润深度、淋巴结转移、TNM分期比较差异均无显著性(P>0.05);AFP升高胃癌组患者的脉管浸润、同时性肝转移比例均显著高于AFP正常胃癌组(P<0.05)。Kaplan-Meier生存曲线显示,AFP升高胃癌组患者的术后5年总生存率显著低于AFP正常胃癌组(P<0.05)。单因素分析结果显示,AFPGC患者的术后5年总生存率与术前血清AFP水平、肿瘤分化程度、淋巴结转移、脉管浸润、同时性肝转移和TNM分期显著相关(P<0.05)。Cox多因素分析结果显示,术前血清AFP水平升高是影响AFPGC患者术后5年总生存率的独立危险因素(P<0.05)。结论AFPGC患者易发生脉管浸润和同时性肝转移,预后往往较差,且术前血清AFP水平升高是AFPGC患者预后不良的独立危险因素。Objective To analyze the Clinicopathological features and prognostic analysis of alpha-fetoprotein-producing gastric cancer(AFPGC).Method The clinical data of 531 patients with gastric cancer who underwent D2 radical surgery in Xuanwu Hospital of Capital Medical University from January 2004 to February 2020 were retrospectively analyzed.All AFPGC(AFP>30μg/L)patients were selected as gastric cancer group of elevated AFP(22 cases).According to the matching principle,22 cases gastric cancer patients with normal AFP level admitted during the same period were selected as gastric cancer group of normal AFP.The clinicopathological features and five-year overall survival rate were compared between the two groups.The independent risk factors affecting the overall survival rate at five years of AFPGC were analyzed.Result In this study,the proportion of AFPGC was 4.14%(22/531).There were no significant differences in tumor size,tumor site,tumor differentiation degree,tumor invasion depth,lymph node metastasis and TNM stage between the two groups(P>0.05).The proportions of vascular infiltration and simultaneous liver metastasis in gastric cancer group of elevated AFP were significantly higher than those in gastric cancer group of normal AFP(P<0.05).Kaplan-Meier survival curve showed that the five-year overall survival rate in gastric cancer group of elevated AFP was significantly lower than that in gastric cancer group of normal AFP(P<0.05).Univariate analysis showed that the five-year overall survival rate of AFPGC patients was significantly correlated with preoperative serum AFP level,tumor differentiation degree,lymph node metastasis,vascular infiltration,synchronous liver metastasis and TNM stage(P<0.05).Multivariate analysis showed that increased preoperative serum AFP level was an independent risk factor for five-year overall survival rate of AFPGC patients(P<0.05).Conclusion Patients with AFPGC are prone to vascular infiltration and synchronous liver metastasis,and the prognosis is often poor,and the preoperative ser

关 键 词：甲胎蛋白升高型胃癌 脉管浸润 同时性肝转移 预后 

分 类 号：R735.2[医药卫生—肿瘤]