Chang Y C, Nagasue N, Abe S, Kohno H, Yamanoi A, Uchida M, Nakamura T
Second Department of Surgery, Shimane Medical University, Izumo, Japan.
Nihon Geka Gakkai Zasshi. 1990 Oct;91(10):1574-80.
During the last decade, we have experienced 525 cases of gastric cancer. Within these, 195 were early gastric cancer (37.1%). Five and eight year survival rates were 86.9 and 77.2%. There were seven cases of recurrence, all of which were liver metastasis of submucosal cancers. Two combined with pulmonary metastasis. Three of the recurrent cases had serum AFP raised (greater than 20ng/ml) before or after partial gastrectomy. When these gastric specimens were reviewed, AFP positive cells were stained by PAP method. Compared with the AFP negative group of 168 early gastric cancers, invasion of lymphatic and venous vessels of the stomach and incidence of the liver metastasis were significantly higher in the stained group. 1.3 and 4.5 year survival rates of the cases (including ours) of AFP producing early gastric cancer, which had been reported in Japanese literatures, were 76.1, 45.7 and 22.9%, respectively. Liver metastasis was found in 7 of 12 cases (58.3%). It is clear that AFP producing early gastric cancer has the same tendency for liver metastasis as the AFP producing advance gastric cancer does. To prevent its recurrence, early diagnosis by PAP method for specimens with hepatic picture and aggressive adjuvant chemotherapy are mandatory.
在过去十年间,我们共诊治了525例胃癌患者。其中,早期胃癌195例(占37.1%)。5年和8年生存率分别为86.9%和77.2%。有7例复发,均为黏膜下癌肝转移,其中2例合并肺转移。3例复发患者在胃部分切除术前或术后血清甲胎蛋白升高(大于20ng/ml)。对这些胃癌标本进行复查时,采用PAP法对甲胎蛋白阳性细胞进行染色。与168例早期胃癌甲胎蛋白阴性组相比,染色组胃淋巴管和血管侵犯及肝转移发生率明显更高。日本文献报道的产甲胎蛋白早期胃癌病例(包括我们的病例)的1.3年、4.5年生存率分别为76.1%、45.7%和22.9%。12例中有7例(占58.3%)发生肝转移。显然,产甲胎蛋白早期胃癌与产甲胎蛋白进展期胃癌具有相同的肝转移倾向。为预防其复发,对有肝脏影像学表现的标本采用PAP法进行早期诊断及积极的辅助化疗是必不可少的。