摘要
目的探讨血清甲胎蛋白（AFP）阳性胃癌患者的临床特点及预后分析。方法回顾性收集大连医科大学附属第一医院普通外科2003年1月至2008年12月间连续收治的512例胃癌患者的临床资料，根据术前血清AFP化学发光法检测结果，分为血清AFP阳性组（50例）和血清AFP阴性组（462例）；比较两组患者的临床特点及生存率，分析血清AFP阳性对胃癌患者预后的影响。结果与血清AFP阴性组相比，血清AFP阳性组患者的肝转移率[36．0％（18／50）比2．6％（12／462），X。=4．20，P〈0．01]和脉管浸润发生率[12．0％（6／50）比3．7％（17／462），X2=7．28，P〈0．05]更高。血清AFP阳性组患者术后中位生存时间为30月，5年生存率为20．8％；血清AFP阴性组术后中位生存时间为42月，5年生存率为27．5％，两组差异具有统计学意义（P〈0．05）。单因素分析显示，术前血清AFP、肿瘤大小、浸润深度、淋巴结转移、病理分期、肝转移、脉管浸润与预后有关（均P〈0．05）；Cox比例风险模型多因素分析结果显示，肿瘤浸润深度（UR：1．464，95％CI：1．068～2．007，P=0．018）、淋巴结转移（HR=1．136，95％c，：1．011～1．275，P=0．032）和肝转移（HR=4．116，95％CI：2．610～6．489，P=0．ooo）是胃癌患者的独立预后因素（均P〈0．05），而术前血清AFP水平并不是影响其预后的独立因素（P〉0．05）。结论血清AFP阳性胃癌更易发生肝转移和脉管浸润；但术前血清AFP水平并不是影响患者预后的独立因素。
Objective To investigate the clinical features and prognosis factors of a-fetoprotein （AFP） positive gastric cancer patients. Methods Clinical data of 512 gastric cancer patients undergoing surgery from January 2003 to December 2008 in the General Surgery Department, the First Aff＇diated Hospital, Dalian Medical University were collected. According to serum AFP level, patients were divided into AFP positive group and AFP negative group. Clinical data and survival time were compared between the two groups. Effect of positive AFP on pmgnasis was evaluate. Results There were 50 AFP positive patients and the ratio was 9.8%. As compared to AFP negative group, AFP positive group had a higher incidence of vascular tumor invasion [ 12.0%（6/50） vs. 3.7%（17/462）, X2 = 7.28, P 〈 0.05] and liver metastasis [36.0%（18/50） vs. 2.6%（12/462）,X2 = 4.20, P 〈 0.01]. The median survival time of AFP positive and negative groups was 30 months and 42 months, the 5-year survival rate was 20.8% and 27.5%, respectively （P 〈 0.05）. Univariate analysis showed that AFP level, tumor size, tumor infiltration, lymphatic metastasis, pathological stage, liver metastasis and vascular tumor invasion were risk factors influencing the prognosis of AFP positive gastric cancer （P 〈 0.05）. Cox analysis showed that the independent prognostic factors included tumor infiltration （HR = 1.464,95% CI： 1.068 - 2.007, P = 0.018）, lymphatic metastasis （HR = 1.136,95% CI： 1.011 - 1.275, P = 0.032） and liver metastasis （HR = 4.116,95% CI：2.610 - 6.489, P = 0.000）, but not AFP level （P 〉 0.05）. Conclusion Gastric cancer patients with positive serum AFP usually present vascular tumor invasion and liver metastasis, but AFP level is not the independent prognostic factor.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2016年第1期67-70,共4页
Chinese Journal of Gastrointestinal Surgery
基金
大连市科学技术基金项目（2012J21DW012）
关键词
胃肿瘤
甲胎蛋白
临床特征
预后
Stomach neoplasms
α-fectoprotein
Clinical features
Prognostic analysis
作者简介
（温世军现在四川省达州市中心医院普通外科工作）
通信作者：刘忠，Email：surgerydoetor@sina．com
