He Ruji, Yang Qinyi, Dong Xuqiang, Wang Yao, Zhang Weiming, Shen Lizong, Zhang Zhihong
Division of Gastrointestinal Surgery, Department of General Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
Department of Pathology, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
Oncotarget. 2017 Apr 4;8(14):23817-23830. doi: 10.18632/oncotarget.15909.
Alpha-fetoprotein-producing gastric cancer (AFPGC) accounts for 1.5%-7.1% of all gastric cancer cases. Compared with other types of gastric cancer, AFPGC is more aggressive and prone to liver and lymph node (LN) metastasis, with extremely poor prognosis. To improve understanding of AFPGC we reviewed a consecutive series of 82 AFPGC patients and investigated the prognostic factors. The incidence of AFPGC among our gastric cancer patients was 1.95%, and 29.27% of AFPGCs were diagnosed with metastasis at the time of presentation, mainly liver metastasis. The serum AFP level of patients with AFPGC was significantly associated with tumor differentiation. Histologically, these AFPGC patients were composed of 34.55% hapatiod type, 58.18% fetal gastrointestinal type, 9.09% yolk sac tumor-like type, and 14.55% mixed type. Patient gender, tumor differentiation, Lauren classification, and number of metastatic lymph nodes showed significant differences among these four subtypes. The overall survival time was 42.02 months and the 3-year cumulative survival rate was 53.13%. Age, American Joint Committee on Cancer (AJCC) TNM staging classification (TNM stage), serum AFP level, and surgery were prognostic factors for overall survival; however, TNM stage was the only independent risk factor for prognosis of AFPGC. In short, AFPGC is a rare, unique, and heterogeneous entity, and its proper identification and treatment remain a challenge. More attention should be paid to AFPGC to improve patient care and the dismal prognosis.
甲胎蛋白生成性胃癌（AFPGC）占所有胃癌病例的1.5%-7.1%。与其他类型的胃癌相比，AFPGC侵袭性更强，更容易发生肝转移和淋巴结转移，预后极差。为了增进对AFPGC的了解，我们回顾了连续82例AFPGC患者，并对预后因素进行了调查。我们的胃癌患者中AFPGC的发病率为1.95%，29.27%的AFPGC患者在就诊时被诊断为有转移，主要是肝转移。AFPGC患者的血清甲胎蛋白水平与肿瘤分化显著相关。组织学上，这些AFPGC患者由34.55%的肝样型、58.18%的胎儿胃肠型、9.09%的卵黄囊瘤样型和14.55%的混合型组成。患者性别、肿瘤分化、劳伦分类和转移淋巴结数量在这四种亚型之间存在显著差异。总生存时间为42.02个月，3年累积生存率为53.13%。年龄、美国癌症联合委员会（AJCC）TNM分期分类（TNM分期）、血清甲胎蛋白水平和手术是总生存的预后因素；然而，TNM分期是AFPGC预后的唯一独立危险因素。简而言之，AFPGC是一种罕见、独特且异质性的实体，其正确识别和治疗仍然是一项挑战。应更加关注AFPGC以改善患者护理和糟糕的预后。
