卢顺利, 李洪涛, 于建平, 陈为凯, 李安东, 陈超, 何清远, 韩晓鹏. 血清甲胎蛋白阳性胃癌患者临床病理特征与预后关系的研究[J]. 中国肿瘤临床, 2023, 50(1): 30-36. DOI: 10.12354/j.issn.1000-8179.2023.20220890
引用本文: 卢顺利, 李洪涛, 于建平, 陈为凯, 李安东, 陈超, 何清远, 韩晓鹏. 血清甲胎蛋白阳性胃癌患者临床病理特征与预后关系的研究[J]. 中国肿瘤临床, 2023, 50(1): 30-36. DOI: 10.12354/j.issn.1000-8179.2023.20220890
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Shunli Lu, Hongtao Li, Jianping Yu, Weikai Chen, Andong Li, Chao Chen, Qingyuan He, Xiaopeng Han. Relationship between clinicopathological features and prognosis of patients with serum alpha-fetoprotein-producing gastric cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(1): 30-36. DOI: 10.12354/j.issn.1000-8179.2023.20220890
Citation: Shunli Lu, Hongtao Li, Jianping Yu, Weikai Chen, Andong Li, Chao Chen, Qingyuan He, Xiaopeng Han. Relationship between clinicopathological features and prognosis of patients with serum alpha-fetoprotein-producing gastric cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(1): 30-36. DOI: 10.12354/j.issn.1000-8179.2023.20220890
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血清甲胎蛋白阳性胃癌患者临床病理特征与预后关系的研究

Relationship between clinicopathological features and prognosis of patients with serum alpha-fetoprotein-producing gastric cancer

    摘要
  • 摘要:
      目的  探讨血清AFP阳性胃癌（alpha-fetoprotein producing gastric cancer ，AFPGC）与普通型胃癌的差异以及其临床病理特征和预后的关系。
      方法  回顾性分析2013年1月至2018年12月在中国人民解放军联勤保障部队第九四〇医院行胃癌手术的患者1 321例，经筛选纳入研究1 144例，分为血清AFP阳性组（53例）与血清AFP阴性组（1 091例）。
      结果  AFPGC占同期胃癌患者的4.6%，AFPGC与血清AFP阴性胃癌1、3、5年累计生存率分别为64.2%与92.2%、20.8%与45.1%、13.2%与25.7%，两者术前血清AFP、肿瘤大小、免疫组织化学HER2、肿瘤部位、浸润深度、淋巴结转移、临床分期、脉管侵犯、手术方式、术后肝转移相比，均差异具有统计学意义（P<0.05）。AFPGC单因素以及Cox多因素生存分析显示：临床分期、脉管侵犯、手术方式、术后肝转移以及术后血清AFP再次升高是影响AFPGC预后的危险因素。
      结论  AFPGC是一种特殊性的胃癌，具有临床分期晚、易发生术后肝转移和脉管侵犯且预后差，AFPGC患者即使肿瘤原发灶被切除后，仍有较高的肝转移风险，且术前血清AFP水平与患者预后无关，而术后监测血清AFP水平可及时发现肿瘤复发及术后肝转移，此外，早期行胃癌根治术有助于改善患者预后。

     

    Abstract:
      Objective  Alpha-fetoprotein-producing gastric cancer (AFPGC) is a rare malignant tumor characterized by its high invasiveness, aggressive metastatic behavior, and poor prognosis. The study aimed to investigate the difference between AFPGC and normal gastric cancer and to analyze the relationship between the clinicopathological features and prognosis of AFPGC.
      Methods  A retrospective analysis, involving 1,321 patients undergoing gastric cancer surgery in 940 Hospitals of PLA Joint Logistics Support Force from January 2013 to December 2018, was conducted. A total of 1,144 patients were screened for gastric cancer surgery according to the inclusion and exclusion criteria. They were assigned into the AFPGC group (53 cases) and the serum AFP negative group (1,091 cases).
      Results  AFPGC accounted for 4.6% of the patients with gastric cancer within the same period. The 1-,3-, and 5-year cumulative survival rates of AFPGC and serum AFP-negative gastric cancer were 64.2% vs 92.2%, 20.8% vs 45.1%, and 13.2% vs 25.7%, respectively. There were significant differences in preoperative serum AFP, tumor size, immunohistochemical HER2, tumor site, depth of invasion, lymph node metastasis, clinical stage, vascular invasion, surgical method, and postoperative liver metastasis between the two groups (P<0.05). Univariate and Cox multivariate survival analysis of AFPGC showed that the clinical stage, vascular invasion, surgical method, postoperative liver metastasis, and postoperative serum AFP re-elevation were associated with a poor prognosis for AFPGC.
      Conclusions   AFPGC is a special type of gastric cancer, which has a late clinical staging, high risk of postoperative liver metastasis and vascular invasion, and poor prognosis. Patients with AFPGC have a high risk of liver metastasis even after primary tumor resection. Preoperative serum AFP level was not related to the prognosis. Postoperative monitoring of serum AFP level facilitates timely detection of tumor recurrence and postoperative liver metastasis. In addition, early radical gastrectomy can help improve the prognosis of patients with AFPGC.

     

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