12例胃肝样腺癌临床病理特征及预后分析  

Clinicopathological Characteristics and Prognosis of 12 Cases of Hepatoid Adenocarcinoma of the Stomach

作　　者：肖雯 苏利君 苗亚萍 罗娜 陈萍 XIAO Wen;SU Lijun;MIAO Yaping;LUO Na;CHEN Ping(First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China;Department of OncologyⅡ,Oncology Hospital of General Hospital of Ningxia Medical University,First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学第一临床医学院,银川750004 [2]宁夏医科大学总医院肿瘤医院肿瘤内二科,宁夏医科大学第一临床医学院,银川750004

出　　处：《宁夏医科大学学报》2024年第6期640-646,共7页Journal of Ningxia Medical University

摘　　要：目的总结12例胃肝样腺癌(HAS)患者临床资料,探讨胃肝样腺癌的临床病理特征及预后。方法回顾性分析2016年1月至2022年12月宁夏医科大学总医院收治的12例HAS患者的临床病理学资料,病理及免疫组化结果由两位病理科医师复阅肿瘤组织切片判定。通过描述性统计方法总结患者的人口统计学和肿瘤特征。运用COX单因素和多因素回归分析胃肝样腺癌患者预后。结果12例患者中男性9例、女性3例,男女比例为3∶1;疾病中位诊断年龄为60岁;最常见发病部位为胃窦(41.7%),病变类型以BorrmannⅢ型(溃疡型)为主(45.5%),Lauren分型以弥漫型为主(58.3%),肿瘤分化程度多呈低分化(83.3%);8例患者血清癌胚抗原(CEA)≥5 ng·mL^(-1),6例患者进行血清甲胎蛋白(AFP)检测,其中4例(66.7%)升高,1例(16.7%)AFP≥300 ng·mL^(-1)。11例患者进行了手术治疗,术前远处转移5例,其中4例同时发生肝脏、腹膜后淋巴结转移;1例仅发生腹膜后淋巴结转移。10例患者(83.3%)发生脉管浸润,7例患者(58.3%)发生神经侵犯。根据肝样分化区所占比例不同,4例患者(33.3%)为单纯型HAS、8例患者(66.7%)为混合型HAS。临床分期:Ⅰ期1例、Ⅱ期1例、Ⅲ期5例、Ⅳ期5例。12例患者中位生存期为16个月,1、3、5年存活率分别为83.0%、41.0%、20.0%。根据单因素分析结果,不排除CEA水平、临床分期、肝样腺癌类型、是否行根治性手术、是否存在远处转移、远处转移是否为肝转移HepPar-1是否表达与患者预后可能有关。结论HAS是一种罕见的异质性肿瘤,常伴血清AFP升高及部分肝细胞癌标记物表达,易发生脉管浸润、淋巴结及远处转移,预后极差。Objective To summarize clinical data and explore the clinicopathological features and prognoses of 12 patients with hepatoid adenocarcinoma of the stomach(HAS).Methods A retrospective analysis was performed on the clinicopathological data of 12 patients with HAS admitted to the General Hospital of Ningxia Medical University from January 2016 to December 2022.The pathological and immunohistochemical results were determined by the review of tumor tissue sections by two pathologists.Patient demographics and tumor characteristics were summarized by descriptive statistical methods.COX univariate and multivariate regression analysis were used to analyze the prognosis of patients.Results Among the 12 patients,9 patients were males and 3 patients were females,with a male-to-female ratio of 3∶1.The median age at diagnosis of disease was 60 years.The most common pathogenesis was located in the antrum(41.7%),and the lesion type was mainly Borrmann typeⅢ(ulcer type)(45.5%),diffuse type according to Lauren classification(58.3%),and the degree of tumor differentiation was mostly poorly differentiated(83.3%).Eight patients had measured serum carcinoembryonic antigen(CEA)≥5 ng·mL^(-1).Serum alpha-fetal protein(AFP)was measured in 6 patients,and AFP levels were elevated in 4(66.7%),including one≥300 ng·mL^(-1)(16.7%).Eleven patients underwent surgery,and 5 cases of preoperative distant metastasis,of which 4 patients had liver and retroperitoneal lymph node metastasis at the same time.Only retroperitoneal lymph node metastases occurred in 1 patient.Vascular invasion occurred in 10 patients(83.3%)and nerve invasion occurred in 7 patients(58.3%).According to the proportion of hepatic differentiation area,4 cases(33.3%)were simple HAS and 8(66.7%)were mixed HAS.Based on the TNM staging of AJCC 8th edition,there were 1 case of stageⅠ,1 case of stageⅡ,5 cases of stageⅢand 5 cases of stageⅣ.The median survival time was 16 months,and the 1,3 and 5-years survival rates were 83.0%,41.0%and 20.0%,respectively.The univariat

关 键 词：胃肝样腺癌 临床病理特征 免疫组化 预后 

分 类 号：R735.2[医药卫生—肿瘤]