摘要
目的 分析血清甲胎蛋白(AFP)阳性胃癌与普通型胃癌相关基因的差异,以及血清AFP阳性胃癌的相关基因与预后的关系.方法 回顾性分析2013年1月至2018年12月在中国人民解放军联勤保障部队第九四○医院1 144例胃癌手术患者的临床资料,并获得血清AFP阳性组,通过匹配方法得到相同病例数的血清AFP阴性组.结果 1 144胃癌患者中血清AFP阳性胃癌患者47例,血清AFP阴性胃癌患者的预后优于血清AFP阳性胃癌患者,1、3、5年累积生存率分别为95.6％比 63.8％、48.9％比 23.4％、26.7％比 14.9％.两组免疫组化检查 AFP、HER2、GPC3、VEGF、SALL4、P53、Ki-67相比差异均有统计学意义(x2=67.758,P＜0.001;x2=4.004,P=0.044;x2=19.299,P＜0.001;x2=5.232,P=0.022;x2=6.359,P=0.012;x2=6.224,P=0.013;x2=5.232,P=0.022).AFP、GPC3、VEGF、SALL4共阳性表达越多就越可能影响pTNM分期、脉管侵犯、肝转移(x2=5.328,P=0.021;P=0.013;x2=5.887,P=0.015;x2=3.923,P=0.048).单因素以及多因素生存分析显示:AFP、GPC3、VEGF、SALL4是影响血清AFP阳性胃癌患者预后的危险因素(HR=3.700,P=0.036;HR=4.237,P=0.003;HR=3.916,P=0.004;HR=3.412,P=0.001).结论 AFP、GPC3、VEGF、SALL4在血清AFP阳性胃癌中过表达,并且与肿瘤分期、淋巴结转移、脉管侵犯以及肝转移均有关,血清AFP阳性胃癌确诊仍需结合免疫组化检查,术前血清AFP水平是筛选AFP阳性胃癌和行AFP免疫组化检查的重要依据.
Abstract
Objective To analyse the differences of related genes between serum alpha-fetoprotein(AFP)positive gastric cancer and AFP negative gastric cancer,and the relationship between related genes and prognosis of serum AFP positive gastric cancer.Methods A total of 1 144 gastric cancer patients undergoing surgery at the 940th Hospital,Joint Logistic Support Force,People's Liberation Army from Jan 2013 to Dec 2018 were retrospectively analyzed.Of them,47 cases were of AFP positive gastric cancer,and 47 serum AFP negative case were obtained by proper matching method.Results Forty-seven patients with serum AFP positive gastric cancer,accounting for 4.1％of all gastric cancer patients during the same period.The prognosis of serum AFP negative gastric cancer is better than that of serum AFP positive gastric cancer.The 1-,3-and 5-year cumulative survival rates were 95.6％vs.63.8％,48.9％vs.23.4％and 26.7％vs.14.9％,respectively.There were statistical differences in the immunohistochemistry of AFP,HER2,VEGF,GPC3,SALL4,P53 and Ki67 between the two groups(x2=67.758,P＜0.001;x2=4.004,P=0.044;x2=19.299,P＜0.001;x2=5.232,P=0.022;x2=6.359,P=0.012;x2=6.224,P=0.013;x2=5.232,P=0.022).The more co-positive expressions of AFP,GPC3,VEGF and SALL4,the more likely they were to affect pTNM stage,vascular invasion and liver metastasis(x2=5.328,P=0.021;P=0.013;x2=5.887,P=0.015;x2=3.923,P=0.048).Univariate and multivariate survival analysis of serum AFP positive gastric cancer showed:AFP,GPC3,VEGF and SALL4 were risk factors for AFP positive gastric cancer(HR=3.700,P=0.036;HR=4.237,P=0.003;HR=3.916,P=0.004;HR=3.412,P=0.001).Conclusions Serum AFP positive gastric cancer is a rare and highly invasive special type of gastric cancer.AFP,GPC3,VEGF and SALL4 are overexpressed in serum AFP positive gastric cancer,which is correlated with tumor stage,vascular invasion and liver metastasis.The final diagnosis of serum AFP positive gastric cancer still needs immunohistochemical examination.Preoperative serum AFP level is an important basis for AFP positive gastric cancer screening and AFP immunohistochemical examination.
维普
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