摘要
目的探讨胃肝样腺癌（HAS）临床病理特点、诊断、治疗及预后。方法回顾性收集2013年1月至2016年5月期间解放军总医院收治的24例经外科手术切除标本并经病理证实为HAS患者的临床资料。所有患者术前均进行血清甲胎蛋白（AFP）、癌胚抗原（CEA）、胃镜及影像学检查（强化CT或B超等），AFP升高患者均排除肝癌、肝硬化及内胚窦瘤等疾病。随访时间截止至2016年6月或患者死亡，生存时间为患者从手术至患者死亡或随访截止时间。结果全组24例占同期本中心手术确诊的胃癌患者总数的1.03%（24/2 326）。患者男19例，女5例，男女比例为3.8∶1.0，患者平均年龄55.9（31~72）岁；其中有2例患者发生肝转移。50.0%（12/24）的患者首发症状为上腹部疼痛不适，25.0%（6/24）的患者因腹胀伴呕吐就诊；其余为进食困难（12.5%，3/24）、呕血（8.3%，2/24）和黑粪（4.2%，1/24）。全组患者术前血清AFP水平升高者10例（41.7%）；术前血清CEA水平升高者5例（20.8%）。全组患者均行手术治疗，其中23例患者行D2胃癌根治术并均获R0切除，另1例行姑息性胃空肠吻合术。本组HAS病变部位于胃窦部11例（45.8%）、贲门部7例（29.2%）、胃体部6例（25.0%）；肿瘤最大直径≥5 cm者10例，平均肿瘤最大径5.7（1.0~12.0）cm。术后病理肿瘤TNM分期：Ⅰb期1例，Ⅱ期7例，Ⅲ期14例，Ⅳ期2例；淋巴结转移N1~3期为20例（83.3%）；低分化肿瘤21例（87.5%），未见高分化病例；有脉管内癌栓形成11例（45.8%）；免疫组化中AFP阳性表达者11例（45.8%）。70.8%（17/24）的HAS患者术后进行了以SOX（奥沙利铂＋替吉奥）或XELOX（奥沙利铂＋卡培他滨）为方案的辅助化疗，5例行免疫治疗，2例行中药治疗。全组共随访0.7~42.0（中位数8.0）月，共9例患者死亡；其中1例为术前发现肝脏及腹腔转移行胃空肠吻合术者，术后20 d死亡，4例患者术后1.5~12.0月出现肝脏多发转移，生存时间为术后3~18月；3例患者于术后2~17月出现局部复发，生存时间为术后6~22月；1例患者术后12月出现腹腔广泛种植转移，生存时间为26月。结论HAS是一种特殊类型的少见胃癌，诊断主要依据病理组织学，预后差，根治性手术切除是主要治疗手段。
ObjectiveTo investigate the clinicopathological characteristics, diagnosis, treatment and prognosis of gastric hepatoid adenocarcinoma （HAS） .MethodsRetrospective analysis of clinicopathological data of 24 cases with gastric HAS diagnosed by surgery and pathology in Chinese PLA General Hospital from January 2013 to May 2016 were carried out. All the patients underwent preoperative serum alpha fetoprotein （AFP） , carcinoembryonic antigen （CEA） , endoscopy and imaging examination （CT or B-mode ultrasonography） , and those with elevated AFP were excluded from liver cancer, cirrhosis, endodermal sinus tumor and other diseases. The follow-up ended in June 2016 or the death of the patient. The survival was from the operation to the death of the patient or the end of follow-up.ResultsThere were a total of 24 cases with gastic HAS, accounting for 1.03% （24/2 326） of the total number of patients with gastric cancer diagnosed at the same time in our center. There were 19 males and 5 females, the ratio of male to female was 3.8： 1.0, the mean age of the patients was 55.9 （31 to 72） years, and 2 of them had liver metastasis. The first symptom in 50% （12/24） patients was epigastric pain, in 25% （6/24） was abdominal distension with vomiting, and the rest included dysphagia （12.5%, 3/24） , hematemesis （8.3%, 2/24） and melena （4.2%, 1/24） . Preoperative serum levels of AFP and CEA were elevated in 10 （41.7%） and 5 patients （20.8%） respectively. All the patients underwent surgical treatment, including 23 cases with D2 radical resection of gastric cancer and R0 resection, and the other of palliative gastrojejunostomy. Lesions of HAS located in gastric antrum in 11 cases （45.8%） , in cardia in 7 cases （29.2%） , and in gastric body in 6 cases （25%） . Tumor maximum diameter of 10 cases was larger than 5 cm, and the average diameter was 5.7 （1.0 to 12.0） cm. Postoperative pathological TNM staging： stage Ⅰb was in 1 cases, stage Ⅱ in 7 cases, stage Ⅲ in 14 cases, stage Ⅳ in 2 cases; lymph node metastasis in stage N1-3 in 20 cases （83.3%） . Poorly-differentiated tumors were found in 21 cases （87.5%） , and no well-differentiated tumors were found. There were 11 cases （45.8%） with formation of intravascular tumor thrombi. In immunohistochemistry, AFP positive expression was found in 11 cases （45.8%） . Seventeen HAS cases （70.8%, 17/24） received postoperative SOX （oxaliplatin＋ S-1） or XELOX （oxaliplatin＋ capecitabine） as adjuvant chemotherapy, 5 cases postoperative immune therapy, and 2 cases postoperative traditional Chinese medicine. All the patients were followed up for 0.7 to 42.0 months （median 8 months） . A total of 9 patients died, of whom, 1 case underwent gastrojejunostomy because of liver and peritoneal metastasis before operation, and died 20 days after surgery; 4 cases died of multiple liver metastases after 1.5 to 12.0 months with survival of 3 to 18 months; 3 cases presented local recurrence after 2 to 17 months with survival of 6 to 22 months; 1 cases had peritoneal metastasis after 12 month with survival of 26 months.ConclusionsHAS is a rare type of gastric cancer with poor prognosis. The diagnosis is mainly based on histopathology, and radical resection is the mainstay treatment.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第9期1035-1039,共5页
Chinese Journal of Gastrointestinal Surgery
关键词
胃肝样腺癌
临床病理
生存期
预后
Gastric hepatoid adenocarcinoma
Clinicopathologic
Survival time
Prognosis
