摘要
目的探讨原发性胃腺鳞癌的临床病理特征、诊治及预后的特点。方法天津医科大学肿瘤医院2001年1月至2011年1月期间共收治胃部肿瘤患者5562例，其中原发性胃腺鳞癌患者42例，占同期胃部肿瘤患者的0．76％。收集该组胃腺鳞癌患者临床病理及随访资料进行回顾性队列研究，采用Cox比例风险模型分析胃腺鳞癌的预后影响因素。结果42例原发性胃腺鳞癌患者中男32例，女10例，男女比例3．2：1．0，平均年龄63（46～77）岁。5例（11．9％）术前病理确诊为腺鳞癌，其余37例术前病理均认为腺癌。根据AJCC第7版关于胃腺癌的TNM分期标准，Ⅱ期5例（11．9％），Ⅲ期30例（71．4％），1V期7例（16．7％）；肿瘤最大径〉5cm者18例（42．9％）；Borrmann分型为Ⅲ～Ⅳ者29例（69．0％），低（或未）分化肿瘤者32例（76．2％）。31例（73．8％）行根治性手术治疗，未行根治性手术治疗者包括3例原发肿瘤侵犯胰腺、1例侵犯横结系膜根部和7例Ⅳ期患者；有37例患者行淋巴结清扫，其中83．8％（31／37）有淋巴结转移。排除7例Ⅳ期患者和10例拒绝辅助化疗的患者，本组25例患者接受辅助化疗方案治疗。全组平均生存时间36．4月，中位生存时间28．0月，术后1、3、5年生存率分别为82．2％、42．3％和18．2％。单因素分析结果显示，肿瘤最大径（x2=4．039，P=0．044）、Borrmann分型（x2=18．728，P=0．000）、肿瘤分化程度（x2=19．612，P=0．000）、手术根治程度（X2=41．452，P=0．000）、是否有淋巴结转移（x2=9．689，P=0．002）及肿瘤分期（x2=26．277，P=0．000）与患者预后有关；多因素分析结果显示，肿瘤分化程度（HR=10．560，95％CI：2．263～49．281，P=0．003）、手术根治程度（HR=4．309，95％CI：1．311—14．168，P=0．016）和肿瘤分期（HR=2．392，95％CI：1．022～5．600，P=0．044）是影响患者预后独立因素。结论原发性胃腺鳞癌罕见且预后差，应优先推荐手术治疗，肿瘤分化程度、手术根治程度及肿瘤分期是评估原发性腺鳞癌患者预后的重要指标。
Objective To investigate the clinicopathological characteristics, diagnosis, treatment and prognosis of patients with primary gastric adenosquamous cell carcinoma. Methods A total of 5 562 patients with gastric neoplasm were admitted in Tianjin Medical University Cancer Institute and Hospital from January 2001 to January 2011. Among them 42 patients were diagnosed as primary gastric adennsquamous cell carcinoma, accounting for 0.76% of all the patients. The clinicopathological and follow-up data of these 42 patients with primary gastric adenosquamous cell carcinoma were retrospectively analyzed, and Cox proportional hazard model was used to analyze the prognostic factors of gastric adenocarcinoma squamous cell carcinoma. Results Among above 42 patients, 32 were male and 10 were female, with a male-to-female ratio of 3.2：1.0 and the average age was 63 years （range： 46 to 77 years）. Five patients （11.9%） were confirmed as adenosquamous cell carcinoma by preoperative pathological examination, while other 37 patients were diagnosed as adenocarcinoma preoperatively. According to the 7th edition AJCC TNM classification system for gastric adenocarcinoma, 5 patients （11.9%） were in stage Ⅱ , 30 patients （71.4%） in stage Ⅲ and 7 patients （16.7%） in stage Ⅳ. The maximum tumor diameter was 〉 5 cm in 18 patients （42.9%）. Borrmann type Ⅲ-Ⅳ was found in 29 patients （69.0%）, and poorly differentiated （or undifferentiated） tumor was found in 32 patients （76.2%）. Radical operations were performed in 31 patients （73.8%）, the reasons of non radical operations included infiltration of pancreas in 3 patients, infiltration of radices mesocili transvers in 1 patient and classification of stage IV in 7 patients. Lymph node dissection was performed in 37 patients, 83.8% of them （31/37） was found with lymphatic metastases. Twenty-five patients received adjuvant chemotherapy except for 7 patients in stage IV and 10 patients who refused adjuvant chemotherapy. All the patients had an average survival time of 36.4 months and median survival time of 28.0 months, and the overall 1-,3- and 5-year survival rates were 82.2% , 42.3% and 18.2% respectively. Univariate analysis revealed that tumor size （X2= 4.039, P= 0.044）, Borrmann type （X2= 18.728, P= 0.000）, tumor differentiation （X2= 19.612, P = 0.000）, radical gastectomy （X2 = 41.452, P= 0.000）, lymph node metastasis （X2 =9.689, P= 0.002） and clinical stage （X2= 26.277, P= 0.000） were associated with postoperative survival. Multivariate analysis revealed that tumor differentiation （HR = 10.560, 95%CI：2.263-49.281, P= 0.003）, radical gastrectomy （HR = 4.309, 95%CI： 1.311- 14.168, P= 0.016） and clinical stage （HR = 2.392, 95%CI： 1.022-5.600, P= 0.044） were independent prognosis factors. Conclusions Primary gastric adenosquamous cell carcinoma is rare with poor prognosis. Radical gastrectomy is recommended. Tumor differentiation, radical gastrectomy and clinical stage are important indicators to evaluate prognosis of primary gastric adenosquamous cell carcinoma.
作者
李斌
孙琳
王晓娜
邓靖宇
丁学伟
王学军
柯彬
张李
张汝鹏
梁寒
Li Bin Sun Lin Wang Xiaona Deng Jingyu Ding Xuewei Wang Xuejun Ke Bin Zhang Li Zhang Rupeng Liang Han(Department of Gastric Cancer Surgery Department of Pathology Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin＇s Clinical Research Center for Cancer, Tianjin 300060, China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第2期207-212,共6页
Chinese Journal of Gastrointestinal Surgery
基金
天津医科大学肿瘤医院博士引进与启动基金（B1406）
国家自然科学基金（81401952）
天津市卫生局科技基金（2014K2082）
关键词
胃肿瘤
腺鳞癌
临床
病理学
预后
Stomach neoplasms
Adenosquamous carcinoma
Clinical
Pathology
Prognosis
