20例原发性胃腺鳞癌临床病理学特征分析  

Analysis of clinicopathological characteristics in 20 cases of primary gastric adenosquamous carcinoma

作　　者：何亚运 史晓辰 高依莎 HE Yayun;SHI Xiaochen;GAO Yisha(Department of Pathology,First Affiliated Hospital of Naval Military Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院病理科,上海200433

出　　处：《重庆医学》2023年第23期3572-3576,共5页Chongqing medicine

基　　金：海军军医大学第一附属医院医学基础研究专项青年培育项目(2021JCQN05)。

摘　　要：目的探讨原发性胃腺鳞癌的临床表现、病理诊断、治疗方法及预后。方法回顾性分析2013年1月1日至2022年11月30日于该院接受手术治疗的20例原发性胃腺鳞癌患者的临床资料,分析其临床病理学特征及预后。结果20例患者中男14例,女6例,中位年龄59(36,74)岁。患者以上腹部不适、疼痛和体重减轻为主要临床症状,部分患者血清糖类抗原19-9(CA19-9)水平升高,影像学检查提示胃占位。20例患者中肿瘤最常见于胃下1/3(14例),其次是上1/3(1例)和中1/3(5例),组织形态学上胃肿瘤细胞中包含腺癌、鳞状细胞癌2种成分,鳞状细胞癌所占肿瘤细胞比例>25%。免疫组织化学显示,腺癌部分肿瘤细胞表达CK8/18,鳞状细胞癌部分肿瘤细胞表达p40。20例患者均行手术治疗,仅6例生存,其余均死于肿瘤复发或转移。鳞状细胞癌占比、Ki-67与胃腺鳞癌患者预后相关(P<0.05)。Kaplan-Meier法构建生存曲线显示,鳞状细胞癌占比>35%时,患者预后较好。结论以腺癌为主的原发性胃腺鳞癌可能与更高的转移风险相关。Objective To investigate the clinical manifestations,pathological diagnosis,treatment method and prognosis of primary gastric adenosquamous carcinoma.Methods The clinical data of 20 patients with primary gastric adenosquamous carcinoma receiving the treatment in this hospital from January 1,2013 to November 30,2022 were retrospectively analyzed,and their clinicopathological characteristics and prognosis were analyzed.Results Among the 20 patients,14 cases were male and 6 cases were female,with a median age of 59(36,74)years old.Upper abdominal discomfort,pain and weight loss were the main clinical symptoms.Serum carbohydrate antigen 19-9(CA19-9)levels were elevated in some patients.The image examination indicated the gastric occupation.Among 20 cases,the tumors were most common in the lower third of the stomach(14 cases),followed by the upper third(1 case)and the middle third(5 cases).The most common tumors were in the lower one-third(14 cases)of the stomach,followed by the middle one-third(5 cases)and upper one-third(1 case).In histomorphology,the gastric tumor cells contained two components,adenocarcinoma and squamous cell carcinoma,and squamous cell carcinoma accounted for more than 25%of tumor cells.Immunohistochemistry showed that the partial tumor cells of adenocarcinoma expressed CK8/18 and partial tumor cells of squamous cell carcinoma expressed p40.All 20 cases performed the surgical treatment.Only 6 cases survived and the others died of tumor recurrence or metastasis.The adenosquamous carcinoma proportion and Ki-67 were correlated with the prognosis in the patients with gastric adenosquamous carcinoma(P<0.05).The survival curve constructed by the Kaplan-Meier method showed that when the proportion of squamous carcinoma was more than 35%,the prognosis of the patients was good.Conclusion Primary gastric adenosquamous carcinoma,mainly composed of adenocarcinoma,may be correlated with a higher risk of metastasis.

关 键 词：胃肿瘤 腺鳞癌 生存分析 增殖指数 预后 

分 类 号：R735.2[医药卫生—肿瘤]