甲胎蛋白阳性胃癌和胃肝样腺癌预后危险因素对比分析  

Comparative analysis of prognostic risk factors between alpha-fetoprotein-positive gastric cancer and gastric hepatoid adenocarcinoma

作　　者：王博达 张垚 付依凡 何阳菘 王新 卢瑗瑗 WANG Boda;ZHANG Yao;FU Yifan;HE Yangsong;WANG Xin;LU Yuanyuan(State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers,National Clinical Research Center for Digestive Diseases,Xijing Hospital of Digestive Diseases,Air Force Medical University,Xi'an 710032,China;Department of Health Management and Medical Education Research,Air Force Medical University,Xi'an 710032,China;Department of Gastroenterology,Tangdu Hospital,Air Force Medical University,Xi'an 710038,China)

机构地区：[1]国家消化系统疾病临床医学研究中心,消化系肿瘤整合防治全国重点实验室,空军军医大学西京消化病医院,陕西西安710032 [2]空军军医大学卫生事业管理与医学教育教研室,陕西西安710032 [3]空军军医大学唐都医院消化内科,陕西西安710038

出　　处：《空军军医大学学报》2024年第3期270-276,共7页Journal of Air Force Medical University

基　　金：国家自然科学基金(82273142);国家“十四五”重点研发计划项目(2022YFC2505104)。

摘　　要：目的 研究甲胎蛋白阳性胃癌(AFPGC)和胃肝样腺癌(HAS)临床病理特征异同及预后危险因素分析。方法 回顾性分析西京医院2015年1月至2020年12月胃癌手术患者信息,共筛选出AFPGC手术患者60例,HAS手术患者39例。从患者病历中检索临床数据并通过电话和短信获得随访数据。采用χ^(2)检验和Fisher精确检验进行统计分析。基于Kaplan-Meier检验方法进行生存分析并使用GraphPad Prism 9绘制变量的生存曲线。所有检验均以α=0.05作为检验标准。结果 HE染色显示HAS具有独特的组织结构,正常胃上皮、肝细胞样分化胃腺癌区和普通胃腺癌区常共存于同一肿瘤组织中。相关性分析显示AFPGC患者肿瘤组织尾型同源盒基因转录因子2免疫组化染色阳性率高于HAS患者(85.0%vs 66.7%,P=0.032),HAS患者肿瘤组织肝细胞样分化标志物甲胎蛋白(AFP)、谷氨酰胺合成酶和人类婆罗双树样基因-4的阳性率均为41.0%,肝细胞石蜡抗原、磷脂酰肌醇蛋白聚糖3的阳性率均为64.1%。AFPGC和HAS的术后3年生存分析无显著性差异,但HAS的术后5年预后差于AFPGC(P=0.062)。血清AFP≥60.4μg/L的AFPGC组3年(P=0.030)及5年(P=0.022)预后均明显差于血清AFP<60.4μg/L组。血清AFP<20μg/L的HAS组3年(P=0.050)和5年(P=0.084)预后均明显差于血清AFP升高的HAS组。结论 HAS目前诊断依赖病理学检查,极易漏诊。HAS术后长期预后差于AFPGC,血清AFP≥60.4μg/L是AFPGC的预后危险因素,血清AFP低表达是HAS的预后危险因素。Objective To study the clinicopathological characteristics and prognostic risk factors of alpha-fetoprotein-positive gastric cancer(AFPGC)and hepatoid adenocarcinoma of the stomach(HAS).Methods The study retrospectively analyzed the clinical data of patients who underwent gastric cancer surgery at Xijing Hospital from January 2015 to December 2020.A total of 60 patients undergoing AFPGC surgery and 39 patients undergoing HAS surgery were included in the analysis.Clinical data were retrieved from patient records,while follow-up data were collected through phone calls and text messages.Chi-square test and Fisher s exact test were used for statistical analysis.Survival analysis was performed based on Kaplan-Meier method,and survival curves of variables were plotted using GraphPad Prism 9.The significance level was set atα=0.05 for all tests to determine statistical accuracy.Results HE staining revealed a distinctive tissue architecture in HAS,characterized by the coexistence of normal gastric epithelium,areas exhibiting hepatocyte-like differentiation in gastric adenocarcinoma,and common gastric adenocarcinoma regions in the same tumor tissue.Correlation analysis revealed a higher positive rate of caudal type homeobox 2 immunohistochemical staining in tumor tissue from AFPGC patients than that from HAS patients(85.0%vs 66.7%,P=0.032).The positive rates of hepatocyte-like differentiation markers in tumor tissues from HAS patients were as follows:alpha-fetoprotein(AFP,41.0%),glutamine synthetase(41.0%),spalt-like transcription factor 4(41.0%),hepatocyte(64.1%),and glypican-3(64.1%).There was no significant difference in the 3-year postoperative survival analysis between AFPGC and HAS,but the 5-year postoperative prognosis of HAS was worse than that of AFPGC(P=0.062).The 3-year(P=0.030)and 5-year(P=0.022)prognosis of AFPGC group with serum AFP≥60.4μg/L was significantly worse than that of AFPGC group with serum AFP<60.4μg/L.The 3-year(P=0.050)and 5-year(P=0.084)prognosis of HAS group with serum AFP<20μg/L was sig

关 键 词：甲胎蛋白 甲胎蛋白阳性胃癌 胃肝样腺癌 临床病理因素 生存分析 预后危险因素 

分 类 号：R735.2[医药卫生—肿瘤]