胃肝样腺癌的临床病理和预后特征。

Clinicopathological and prognostic features of hepatoid adenocarcinoma of the stomach.

机构信息

Department of Abdominal Surgical Oncology, Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100021, China.

出版信息

Chin Med J (Engl). 2011 May;124(10):1470-6.

PMID:21740800

Abstract

BACKGROUND

Hepatoid adenocarcinoma of the stomach (HAS) is a rare type of gastric carcinoma, which has its unique clinicopathological features and poorer prognosis than that of the ordinary gastric adenocarcinoma. At present, there is still a lack of understanding about this disease. The current study aimed to summarize and discuss the clinical, pathological, immunohistochemical, and prognostic features of this disease.

METHODS

A total of 20 patients of HAS were retrospectively studied. All the patients were treated in Cancer Hospital of Chinese Academy of Medical Sciences between March 1998 and October 2009. Statistical analysis, including the Kaplan-Meier method, log-rank test and Cox model, were performed by the SPSS 15.0 software.

RESULTS

Seventeen patients (85%) had at least 1 lymph node metastases; 17 patients (85%) received postoperative immunohistochemical examinations, with an alpha-fetoprotein (AFP) positive rate of 94.1% (16/17); 14 patients had distant metastases (including 12 liver metastases, 1 lung metastasis, and 1 celiac widespread metastases), and one simultaneously had anastomotic recurrence and liver metastases. The overall survival time was 2 - 99 months (median: 12.0 months). The 3-year survival rate of the 20 patients was 17.2%. The 3-year survival rate of patients with complete hepatocyte-like regions and those with both hepatocellular carcinoma and adenocarcinoma regions was 20.0% and 17.5%, respectively (P = 0.361). The survival difference among the radical surgery group, palliative surgery group and no surgery group was statistically significant (P = 0.022). The Kaplan-Meier method and log-rank test showed that surgery, pTNM stages, and adjuvant chemotherapy were associated with prognosis (P < 0.05). The Cox model only confirmed that the pTNM stages and adjuvant chemotherapy had statistical significance for the prognosis of HAS (P < 0.05) due to the limited cases.

CONCLUSIONS

HAS is a special type of gastric carcinoma and has a poor prognosis. The pTNM stage is an independent risk factor for HAS. Multidisciplinary therapy, including surgery and chemotherapy, may improve the prognosis of HAS.

摘要

背景

胃肝样腺癌（HAS）是一种罕见的胃腺癌，具有独特的临床病理特征，比普通胃腺癌预后更差。目前，对这种疾病的认识仍存在不足。本研究旨在总结和探讨该病的临床、病理、免疫组化和预后特征。

方法

回顾性分析 1998 年 3 月至 2009 年 10 月在中国医学科学院肿瘤医院治疗的 20 例 HAS 患者的临床病理资料。采用 Kaplan-Meier 法、log-rank 检验和 Cox 模型进行统计学分析，应用 SPSS 15.0 软件进行分析。

结果

17 例（85%）至少有 1 枚淋巴结转移；17 例（85%）术后行免疫组化检查，甲胎蛋白（AFP）阳性率为 94.1%（16/17）；14 例发生远处转移（包括 12 例肝转移、1 例肺转移、1 例腹腔广泛转移），1 例同时发生吻合口复发和肝转移。全组中位生存时间为 12.0 个月，20 例患者 3 年生存率为 17.2%。完全呈肝样细胞区域和同时存在肝细胞癌和腺癌区域的患者 3 年生存率分别为 20.0%和 17.5%（P=0.361）。根治性手术组、姑息性手术组和未手术组患者的生存差异有统计学意义（P=0.022）。Kaplan-Meier 法和 log-rank 检验显示，手术、pTNM 分期和辅助化疗与预后相关（P<0.05）。Cox 模型仅证实 pTNM 分期和辅助化疗对 HAS 的预后有统计学意义（P<0.05），这可能与病例数有限有关。