Adachi Yosuke, Tsuchihashi Junko, Shiraishi Norio, Yasuda Kazuhiro, Etoh Tsuyoshi, Kitano Seigo
First Department of Surgery, Oita Medical University, Oita, Japan.
Oncology. 2003;65(2):95-101. doi: 10.1159/000072332.
Serum alpha-fetoprotein (AFP) is sometimes high in patients with primary gastric carcinoma, and there is no comprehensive study on the clinicopathologic characteristics and prognostic factors of AFP-producing gastric carcinoma (AGC). To clarify the variables associated with the survival after gastrectomy for AGC, we reviewed the data of patients with AGC and examined the independent prognostic factors. We studied 270 cases of AGC reported in the Japanese literature from June 1982 to March 2001, together with 1 patient of our own experience. The clinicopathologic findings, including serum AFP level, operative curability, and stage of the disease were examined, and factors associated with survival were determined by multivariate analysis. There were 15 stage I tumors (6%), 50 stage II tumors (19%), 51 stage III tumors (20%), and 145 stage IV tumors (55%). The tumors were characterized by frequent serosal invasion (75%), lymph node metastasis (83%), liver metastasis (33%), stage III or IV disease (75%), and noncurative operation (48%). The survival was influenced by the serum AFP level, tumor size, serosal invasion, lymph node metastasis, and liver metastasis, but the independent prognostic factors were operative curability (curative vs. noncurative) and stage of the disease (I, II vs. III, IV). Although the 5-year survival rate and median survival period in all patients were 22% and 14 months, respectively, those in patients with curative gastrectomy were 42% and 29 months, respectively. The results indicate that operative curability and stage of the disease are factors associated with the survival of patients with AGC. Although tumors are often advanced and complicated with liver metastases, long-term survival can be achieved when patients with stage I or II tumor undergo curative gastrectomy.
原发性胃癌患者的血清甲胎蛋白（AFP）有时会升高，目前尚无关于产AFP胃癌（AGC）临床病理特征及预后因素的综合研究。为明确与AGC胃切除术后生存相关的变量，我们回顾了AGC患者的数据并检查了独立预后因素。我们研究了1982年6月至2001年3月日本文献报道的270例AGC病例，以及1例我们自己诊治的病例。检查了包括血清AFP水平、手术可治愈性和疾病分期在内的临床病理结果，并通过多因素分析确定了与生存相关的因素。有15例I期肿瘤（6%），50例II期肿瘤（19%），51例III期肿瘤（20%），145例IV期肿瘤（55%）。这些肿瘤的特点是浆膜侵犯频繁（75%）、淋巴结转移（83%）、肝转移（33%）、III期或IV期疾病（75%）以及非根治性手术（48%）。生存受血清AFP水平、肿瘤大小、浆膜侵犯、淋巴结转移和肝转移影响，但独立预后因素是手术可治愈性（根治性与非根治性）和疾病分期（I、II期与III、IV期）。虽然所有患者的5年生存率和中位生存期分别为22%和14个月，但根治性胃切除术患者的5年生存率和中位生存期分别为42%和29个月。结果表明，手术可治愈性和疾病分期是与AGC患者生存相关的因素。尽管肿瘤常处于晚期并伴有肝转移，但I期或II期肿瘤患者接受根治性胃切除术后可实现长期生存。
