血清AFP阳性晚期胃癌患者的临床分析

摘要

目的：探讨血清甲胎蛋白（alpha-fetoprotein，AFP）阳性且无法行手术治疗的晚期胃癌患者的临床病理特征、化疗疗效和临床预后。方法：回顾性分析江苏省肿瘤医院2012年12月至2014年12月收治的无法行手术治疗的136例晚期胃癌患者，分析血清AFP与晚期胃癌患者的临床病理特征与化疗、生存及预后的关系。结果：本组患者中血清AFP阳性胃癌（AFP-producing gastric cancer，AFPGC）患者为18.4%（25/136）。血清AFP阳性患者与阴性者相比，更易出现淋巴结以外的脏器转移（80.0%vs.55.9%，P=0.026），尤其易出现肝转移（56.0%vs.19.8%，P<0.001）。血清AFP阳性组化疗有效率高（40.0%vs.33.3%），而血清AFP阴性组疾病控制率更高（79.3%vs.68.0%），两者差异均无统计学意义。血清AFP阴性组患者无进展生存时间（progression-free survival， PFS）更长（6.6个月vs.5.0个月），1年生存率更高（72.5%vs.57.9%），但差异无统计学意义。血清AFP阴性组患者中位总生存时间（overall survival，OS）更长（18.0个月vs.12.6个月，P=0.022）。经Cox多因素危险度分析，AFP表达并非胃癌患者的独立危险因素（P=0.061）。血清AFP阳性组患者OS≥12个月，3药联合化疗为紫杉类联合氟尿嘧啶类和铂类治疗比率明显较OS<12个月的患者高（P=0.020）。结论：晚期胃癌患者较早期患者血清AFP阳性率更高，血清AFP阳性者易出现淋巴结外的其它脏器转移，尤其是肝转移，生存期短，3药联合化疗方案能延长生存期。%Objective:To investigate the clinicopathological characteristics, chemotherapeutic effect, and prognosis of serum alpha-fe-toprotein (AFP)-producing advanced gastric cancer. Methods:A total of 136 cases of inoperable advanced gastric cancer in our hospi-tal from December 2012 to December 2014 were included. The relationship between serum AFP with clinicopathological characteris-tics, chemotherapeutic effect, survival, and prognosis were retrospectively analyzed. Results:Among the 136 cases of inoperable ad-vanced gastric cancer, 25 cases (18.4%) were of AFP-producing gastric cancer (AFPGC). Compared with the AFP-negative group, AFPGC patients were prone to have disease metastasis to other organs, particularly the liver (56.0%vs. 19.8%, P<0.001), aside from lymph node metastasis (80.0%vs. 55.9%, P=0.026). The AFPGC patients had a higher remission rate compared with the AFP-negative group (40.0% vs. 33.3%), whereas the AFP-negative group had a higher disease control rate compared with the AFPGC group (79.3% vs. 68.0%). Both had no statistical significance. In the AFP-negative group, median progression-free survival was longer than that of the AF-PGC patients (6.6 months vs. 5.0 months). Meanwhile, one-year survival rate of AFPGC patients was higher than that of AFP-positive group (72.5%vs. 57.9%). Both had no statistical significance. Median overall survival was longer in the AFP-negative group than in the AFPGC group (18.0 months vs. 12.6 months, P=0.022). According to COX model multivariate risk analysis, AFP expression was not an in-dependent risk factor of advanced gastric cancer patients (P=0.061). In the AFPGC group, patients who underwent chemotherapy with three drugs survived at least 12 months or more, whereas those who did not undergo three drug chemotherapy survived less than 12 months (P=0.020). Conclusion:Positive serum AFP level was higher in patients with advanced gastric cancer than in those with early-stage gastric cancer. In the AFPGC group, aside from metastasis to the lymph nodes, the disease also metastasized to other organs, par-ticularly the liver. The AFPGC group also had shorter survival time. Nevertheless, chemotherapy with three drugs prolonged their sur-vival time.