胃肝样腺癌：在摸索和争议中前进

胃肝样腺癌（hepatoid adenocarcinoma of stomach,HAS）是一种特殊类型的胃癌。其发病率不高,但由于HAS具有高度侵袭性的生物学行为,容易发生淋巴转移及肝转移,预后较差,受到临床广泛关注。随着HAS临床病理特征、预后以及分子生物学特征等的持续研究,关于HAS的认识正不断深入。然而,目前在HAS研究领域仍存在一些容易被忽视并亟需解决的问题。本文梳理既往关于HAS的病例报道及研究,在HAS的范畴、起源、诊断方法、分子生物学特征及预后等方面进行总结和探讨,以期为HAS的后续研究提供一定方向。     

Processed meat consumption, dietary nitrosamines and stomach cancer risk in a cohort of Swedish women

Processed meat consumption has been associated with an increased risk of stomach cancer in some epidemiological studies (mainly case-control). Nitrosamines may be responsible for this association, but few studies have directly examined nitrosamine intake in relation to stomach cancer risk. We prospectively investigated the associations between intakes of processed meat, other meats and N-nitrosodimethylamine (the most frequently occurring nitrosamine in foods) with risk of stomach cancer among 61,433 women who were enrolled in the population-based Swedish Mammography Cohort. Information on diet was collected at baseline (between 1987 and 1990) and updated in 1997. During 18 years of follow-up, 156 incident cases of stomach cancer were ascertained. High consumption of processed meat, but not of other meats (i.e., red meat, fish and poultry), was associated with a statistically significant increased risk of stomach cancer. After adjustment for potential confounders, the hazard ratios for the highest compared with the lowest category of intake were 1.66 (95% CI = 1.13-2.45) for all processed meats, 1.55 (95% CI = 1.00-2.41) for bacon or side pork, 1.50 (95% CI = 0.93-2.41) for sausage or hotdogs and 1.48 (95% CI= 0.99-2.22) for ham or salami. Stomach cancer risk was 2-fold higher among women in the top quintile of N-nitrosodimethylamine intake when compared with those in the bottom quintile (hazard ratio = 1.96; 95% CI = 1.08-3.58). Our findings suggest that high consumption of processed meat may increase the risk of stomach cancer. Dietary nitrosamines might be responsible for the positive association.     

Carotenoids/vitamin C and smoking-related bladder cancer

Previous epidemiological studies of fruit and vegetable intake and bladder cancer risk have yielded inconsistent results, especially with respect to the role of cigarette smoking as a possible modifier of the diet-bladder cancer association. A population-based case-control study was conducted in nonAsians of Los Angeles, California, which included 1,592 bladder cancer patients and an equal number of neighborhood controls matched to the index cases by sex, date of birth (within 5 years) and race between January 1, 1987 and April 30, 1996. Information on smoking, medical and medication history, and intake frequencies of food groups rich in preformed nitrosamines, vitamins A and C and various carotenoids, were collected through in-person, structured interviews. Beginning in January 1992, all case patients and their matched control subjects were asked for a blood sample donation at the end of the in-person interviews for measurements of 3- and 4-aminobiphenyl (ABP) hemoglobin adducts, and glutathione S-transferases M1/T1/P1 (GSTM1/T1/P1) and N-acetyltransferase-1 (NAT1) genotypes. Seven hundred seventy-one (74%) case patients and 775 (79%) control subjects consented to the blood donation requests. In addition, all case patients and matched control subjects were asked to donate an overnight urine specimen following caffeine consumption for measurements of cytochrome P4501A2 (CYP1A2) and N-acetyltransferase-2 (NAT2) phenotypes. Urine specimens were collected from 724 (69%) case patients and 689 (70%) control subjects. After adjustment for nondietary risk factors including cigarette smoking, there were strong inverse associations between bladder cancer risk and intake of dark-green vegetables [p value for linear trend (p) = 0.01], yellow-orange vegetables (p = 0.01), citrus fruits/juices (p = 0.002) and tomato products (p = 0.03). In terms of nutrients, bladder cancer risk was inversely associated with intake of both total carotenoids (p = 0.004) and vitamin C (p = 0.02). There was a close correlation (r = 0.58, p = 0.0001) between intakes of total carotenoids and vitamin C in study subjects. When both nutrients were included in a multivariate logistic regression model, only total carotenoids exhibited a residual effect that was of borderline statistical significance (p = 0.07 and p = 0.40 for total carotenoids and vitamin C, respectively). Cigarette smoking was a strong modifier of the observed dietary effects; these protective effects were confined largely to ever smokers and were stronger in current than ex-smokers. Smokers showed a statistically significant or borderline statistically significant decrease in 3- and 4-aminobiphenyl (ABP)-hemoglobin adduct level with increasing intake of carotenoids (p = 0.04 and 0.05, respectively). The protective effect of carotenoids on bladder cancer seemed to be influenced by NAT1 genotype, NAT2 phenotype and CYP1A2 phenotype; the association was mainly confined to subjects possessing the putative NAT1-rapid, NAT2-rapid and CYP1A2-rapid genotype/phenotype. The carotenoid-bladder cancer association was not affected by the GSTM1, GSTT1 and GSTP1 genotypes.     

同型半胱氨酸、维生素D、C、E、B12及叶酸与胃癌关系的研究进展北大核心

胃癌作为临床最常见的肿瘤之一,常因确诊疾病较晚而影响治疗效果,胃镜活检后的病理虽然作为确诊的金标准,但是由于此方式过程痛苦,操作复杂,费用较高,且具有侵入性,可能会导致患者拒绝操作而难普及于临床,因此积极找寻胃癌有效的监测指标十分必要。近年来,很多学者研究维生素与胃癌的相关关系,并试图通过摄取某些维生素降低胃癌发生率,延缓病情及改善预后,也有通过检测血清中维生素的水平给早期胃癌的诊断提供帮助。本文就同型半胱氨酸、维生素D、维生素C、维生素E、维生素B12及叶酸在胃癌中的作用机制,及其在血清中水平与胃癌关系的相关研究进展进行简要综述,为临床胃癌诊疗提供新思路。     

维生素C对顺铂治疗大鼠卵巢癌疗效的影响

目的：探讨维生素 C 是否能影响顺铂对于大鼠卵巢癌的化疗效用,并对其作用机制进行初探。方法：建立卵巢癌大鼠模型,将大鼠随机分组后腹腔给药,每周观察一般状况变化。8周后,脱颈处死各组大鼠,取血清检测 CA125、HE4并计算 ROMA 值,测量腹水容积,解剖并观察统计肿瘤生长情况,对局部肿块及主要组织进行测量,常规病理学检查。结果：所有大鼠外观消瘦,体重随着腹水和肿瘤的出现呈现增长,顺铂+高剂量维生素 C 组的肿瘤质量及腹水容积明显小于其余三组,实验组的 CA125、HE4及 ROMA 明显低于对照组,顺铂+高剂量维生素 C 组的 CA125、HE4及 ROMA 则明显低于顺铂+低剂量维生素 C 组及顺铂组,实验组患恶性肿瘤的大鼠比例降低,而是否添加维生素 C 对数据则无明显影响。结论：注射较高浓度维生素 C 能增强顺铂杀伤卵巢癌的能力,并呈现一定的剂量依赖性。     

Flavonoids and risk of squamous cell esophageal cancer

The relation between 5 classes of flavonoids (flavanones, flavan-3-ols, flavonols, flavones and anthocyanidines) and esophageal cancer was investigated using data from a case-control study conducted between 1992 and 1997 in 3 areas of northern Italy. The study included 304 cases (275 men, 29 women) with a first diagnosis of squamous-cell carcinoma of the esophagus and 743 controls (593 men, 150 women) with no history of cancer, admitted for acute illnesses, unrelated to tobacco and alcohol consumption, to major hospitals of the areas under surveillance. Dietary habits were investigated using a validated food frequency questionnaire. Odds ratios (ORs) and 95% confidence intervals (CI) were computed after allowance for age, sex, study centre, years of education, alcohol drinking, tobacco smoking, body mass index and energy intake. An inverse association emerged between flavanone intake and esophageal cancer risk (OR=0.38 for the highest vs. the lowest quintile, 95% CI=0.23-0.66). The inverse relation between flavanones and esophageal cancer tended to be stronger in those who drank >or=6 drinks/day. In conclusion, this study suggests that flavanone intake is inversely associated with esophageal cancer risk and may account, with vitamin C, for the protective effect of fruit, especially citrus fruit, on esophageal cancer.     

维生素C对顺铂杀伤卵巢癌细胞的影响

目的:探讨维生素C 是否能影响顺铂杀伤卵巢癌细胞株OVCAR5、SKOV3、CAOV3,并对其作用机制进行初探。方法:使用梯度浓度维生素C及顺铂处理卵巢癌细胞株,显微镜下观测细胞的形态学变化;使用ATP-TCA方法检测细胞生长抑制情况。选择对维生素C敏感的卵巢癌细胞株。氧化敏感探针DCFH-DA标记细胞 ,检测不同浓度维生素C处理不同时间后细胞内过氧化氢(H2O2 )水平。结果:三株卵巢癌细胞维生素C处理的敏感度不同,但总体呈现出随着维生素C浓度的增加,细胞受到抑制作用增加,维生素C对于顺铂杀伤细胞的作用具有辅助加强效应,该作用呈现剂量依赖效应。其中较低浓度维生素C处理OVCAR5细胞15min各组胞内H2O2 水平相比对照组稍高,当处理浓度为5 000μmol/L时细胞H2O2 水平明显升高,达到164%。培养30min后,荧光强度显示细胞内H2O2 水平比15min时升高更明显。不同浓度组分别达到对照组的94%、106%、122%、188%,培养60min后检测荧光强度发现各给药组H2O2 水平均已低于对照组。12h后检测到细胞内的H2O2 水平处于更低水平,各组均未达到对照组的50%。结论:较高浓度维生素C能增强顺铂杀伤卵巢癌细胞株的能力,并呈现一定的剂量依赖性。该结果可能由于维生素 C通过自氧化机制产生过氧化氢促进卵巢癌细胞凋亡。     

A case-control study of stomach cancer in Mumbai,India

Stomach cancer incidence rates are much lower in India than elsewhere, but the stomach remains one of the 10 leading sites of cancer in both sexes in most of the metropolitan registries. This is an unmatched case-control study of stomach cancer carried out at Tata Memorial Hospital (TMH), Mumbai. Our purpose was to identify the association of tobacco and alcohol use, occupational hazards, diet, consumption of beverages like tea and coffee, the living environment, cooking media and literacy with stomach cancer. Our study included 170 stomach cancer cases and 2,184 hospital controls interviewed during the period 1988-1992. Tobacco chewing, bidi or cigarette smoking and alcohol drinking did not emerge as high risk factors for stomach cancer. Consumption of dry fish at least once a week compared to never or once a every 2 weeks showed a 12-fold excess risk (OR = 12.4, 95% CI 7.0-22.1, p < 0.0001) for stomach cancer among the nonvegetarian food items considered. A protective effect of tea consumption (OR = 0.4, 95% CI 0.2-0.9, p = 0.03), showing 59% reduction in risk, was identified, which could be of use for possible control and prevention of this cancer.     

The clinicopathological features, treatment and survival of gastric adenocarcinoma in Omani Arab patients

Background: Gastric carcinoma (GC) is the second most frequent cancer worldwide and the most common cancer in the Sultanate of Oman. The surgical and medical management of GC varies worldwide, and variable ethnic differences in clinicopathological features and survival have been observed. The aim of this work was to study clinicopathological features, management and survival trends of GC in Oman and to assess the impact of aggressive management trends on survival. Methods: A retrospective study of gastric adenocarcinoma cases, treated at three main hospitals in Oman over a 12‐year period, was undertaken. The study was divided into period I (1993–1998) and period II (1999–2004), based on the evolution of cancer services. Results: A population of 339 patients was included in the study (M : F ratio 1.9 : 1). GC was mainly a disease of elderly males with mean ages of 60.3 and 59.3 years for periods I and II, respectively. The most prevalent types of GC observed during periods I and II were distal (60.7% vs. 57.7%), ulcerating (64.3% vs. 63.7%) and intestinal (80.9% vs. 78.4%), with no significant differences between them. The main histopathology was adenocarcinoma with an increase in the signet cell variant (4% to 12.1%, P, 0.03) during period II. Advanced stages III and IV constituted 71.1% and 76.5% of all patients in periods I and II, respectively (P, 0.9). More D2 lymph node dissections and increased use of adjuvant chemo‐radiotherapy and palliative chemotherapy were noted during period II. Median survival time for the entire cohort was 12.3 months (95% CI 9.7–14.4) with a 5‐year overall survival rate of 16.5%. The 5‐year overall survival for periods I and II was 14% and 19% (P, 0.27), respectively. Conclusion: GC in Oman is seen predominantly in elderly males who display predominately distal, ulcerative lesions with an intestinal‐type histology. GC continues to present in advanced stages, with poor prognosis. This fact underscores the need for early diagnosis to achieve a better outcome. There is a need to employ early detection policies of gastric cancer in developing countires as aggressive treatment does not alter the outcome of advanced presentaion.     

Review of high‐dose intravenous vitamin C as an anticancer agent

In the 1970s, Pauling and Cameron reported increased survival of patients with advanced cancer treated with high‐dose intravenous (IV) vitamin C (L‐ascorbate, ascorbic acid). These studies were criticized for their retrospective nature and lack of standardization of key prognostic factors including performance status. Subsequently, several well‐designed randomized controlled trials failed to demonstrate a significant survival benefit, although these trials used high‐dose oral vitamin C. Marked differences are now recognized in the pharmacokinetics of vitamin C with oral and IV administration, opening the issue of therapeutic efficacy to question. In vitro evidence suggests that vitamin C functions at low concentrations as an antioxidant but may have pro‐oxidant activity at high concentrations. The mechanism of its pro‐oxidant action is not fully understood, and both intra‐ and extracellular mechanisms that generate hydrogen peroxide have been proposed. It remains to be proven whether vitamin C‐induced reactive oxygen species occur in vivo and, if so, whether this will translate to a clinical benefit. Current clinical evidence for a therapeutic effect of high‐dose IV vitamin C is ambiguous, being based on case series. The interpretation and validation of these studies is hindered by limited correlation of plasma vitamin C concentrations with response. The methodology exists to determine if there is a role for high‐dose IV vitamin C in the treatment of cancer, but the limited understanding of its pharmacodynamic properties makes this challenging. Currently, the use of high‐dose IV vitamin C cannot be recommended outside of a clinical trial.     

A case-control study of stomach cancer and its relation to diet,cigarettes, and alcohol consumption in Saitama Prefecture,Japan

A case-control study of stomach cancer in relation to dietary, smoking, and drinking habits was undertaken in Saitama Prefectur, Japan. The study was based on 294 cases of newly diagnosed adenocarcinoma of the stomach at a single institution, 294 general population controls (matched by sex, age, and administrative division), and 202 hospital controls. Dietary habits were investigated based on the intake of 12 separate foods and 12 food groups in a food frequency questionnaire, together with individual food preferences. The consumption of raw vegetables was inversely related to the risk of stomach cancer, with a dose-response relation observed consistently in the comparisons with both sets of controls. Current cigarette smokers (1–29/day) had an increased risk (relative risk = 1.8,95 percent confidence interval = 1.1–3.0) compared with nonsmokers in the general population controls, but no dose-response effect with heavier cigarette smoking. Alcohol use did not affect the risk of stomach cancer. In the multiple logistic regression, the comsumption of raw vegetables showed a protective effect on stomach cancer while cigarette smoking had no significant association, in both sets of controls.Drs Hoshiyama and Sasaba are in the Department of Epidemiology, Saitama Cancer Center Research Institute, Japan. Address correspondence to Dr Hoshiyama, Komuro 818, Ina, Saitama 362, Japan.     

Prospective study of vitamins C, E, and A and carotenoids and risk of oral premalignant lesions in men

Case-control studies indicate that vitamins C, E, A and carotenoids decrease risk of oral premalignant lesions (OPLs) and oral cancer, but clinical trials have failed to find protective effects of beta-carotene and suggest that vitamin E may increase risk. The authors prospectively evaluated the association between intake of vitamins C, E, A and carotenoids and incidence of OPL. Participants were 42,340 men in the Health Professionals Follow-up Study who provided information on supplement use and diet every 2-4 years by food frequency questionnaire. The authors confirmed 207 clinically or histopathologically diagnosed OPL events occurring between 1986 and 2002 by medical record review. Multivariate-adjusted relative risks (RR) of OPL were calculated with proportional hazards models. Total intake of vitamin C, vitamin A or carotenoids was not significantly associated with OPL risk. Dietary vitamin C was significantly associated with reduced risk (quintile 5 vs. 1, RR = 0.52, 95% CI 0.31-0.85, p(trend) = 0.04), but no association with supplemental vitamin C was observed. Inverse associations were apparent for beta-cryptoxanthin and alpha-carotene intake. No clear relationship emerged with beta-carotene, lycopene or lutein/zeaxanthin. Vitamin E was associated with increased risk (quintile 5 vs. 1, RR = 1.86, 95% CI 1.06-3.19), particularly among current smokers and with supplemental intake (current-smokers, supplement dose tertile 3 vs. 1, RR = 3.07, 95% CI 1.28-7.34, p(trend) = 0.01). For current smokers, beta-carotene also increased risk. Vitamin C from dietary sources, but not supplements, was associated with a reduced risk of OPL. The observed increased risk for current smokers with high vitamin E or beta-carotene intake should be explored further.     

A phase II study of mitomycin C and oral etoposide for advanced adenocarcinoma of the upper gastrointestinal tract

Background: Mitomycin C and etoposide have both demonstrated activityagainst gastric carcinoma. Etoposide is a topoisomerase II inhibitor withevidence for phase-specific and schedule-dependent activity.Patients and method: Twenty-eight consecutive patients with advancedupper gastrointestinal adenocarcinoma were treated with intravenous (i.v.)bolus mitomycin C 6 mg/m² on day 1 every 21 days to a maximumof four courses. Oral etoposide capsules 50 mg b.i.d. (or 35 mg b.i.d. liquid)were administered days 1 to 10 extending to 14 days in subsequent courses ifabsolute neutrophil count >1.5 × 10⁹/l on day 14 offirst course, for up to six courses.Results: Twenty-six patients were assessed for response of whom 12had measurable disease and 14 evaluable disease. Four patients had adocumented response (one complete remission, three partial remissions) withan objective response rate of 15% (95% confidence interval(95% CI) 4%–35%). Eight patients had stable diseaseand 14 progressive disease. The median survival was six months. The schedulewas well tolerated with no treatment-related deaths. Nine patients experiencedleucopenia (seven grade II and two grade III). Nausea and vomiting (eightgrade II, one grade III), fatigue (eight grade II, two grade III) and anaemia(seven grade II, two grade III) were the predominant toxicities.Conclusion: This out-patient schedule is well tolerated and showsmodest activity in the treatment of advanced upper gastrointestinaladenocarcinoma. Further studies using protracted schedules of etoposide bothorally and as infusional treatment should be developed.     

A prospective cohort study of soy product intake and stomach cancer death

The relationship between intake of soy products and death from stomach cancer was examined in a community-based prospective study of Japanese men and women in Takayama, Japan. Over 7 years of follow-up, 121 deaths from stomach cancer (81 men and 40 women) occurred among 30,304 (13,880 men and 16,424 women) participants who were at least 35 years of age. Diet including the intake of soy products and isoflavones was assessed by a validated semiquantitative food-frequency questionnaire at the beginning of the study. In men, the highest compared to the lowest tertile of total soy product intake was significantly inversely associated with death from stomach cancer after controlling for covariates (hazard ratios=0.50; 95% confidence intervals (CIs) 0.26-0.93, P for trend=0.03). Decreased hazard ratios for the highest compared to the lowest tertiles of total soy product intake (hazard ratios=0.49; 95% CI 0.22-1.13) was observed in women, although this association was of marginal significance. These data suggest that soy intake may reduce the risk of death from stomach cancer.     

Glycemic load, glycemic index and carbohydrate intake in relation to risk of stomach cancer: a prospective study

The glycemic effects of diets high in refined grains and starchy foods might increase stomach cancer risk by affecting circulating glucose, insulin and insulin-like growth factor-I levels. No prospective data on the role of high glycemic load and glycemic index diets on stomach cancer risk have been reported. We therefore prospectively investigated dietary glycemic load, overall glycemic index and carbohydrate intake in relation to the incidence of stomach cancer among 61,433 women in the population-based Swedish Mammography Cohort. Diet was assessed at baseline (1987-1990) and again in 1997. During 903,586 person-years of follow-up, a total of 156 incident cases of stomach cancer were ascertained. We observed no material associations of dietary glycemic load, overall glycemic index and total carbohydrate intake with the risk of stomach cancer. The multivariate hazard ratios for the highest versus the lowest quintile were 0.76 (95% CI = 0.46-1.25) for glycemic load, 0.77 (95% CI = 0.46-1.30) for overall glycemic index and 0.85 (95% CI = 0.50-1.43) for carbohydrate intake. The associations did not vary according to body mass index. Lack of information on Helicobacter pylori infection status did not allow stratification by this potential effect modifier. Findings from this population-based prospective cohort of middle-aged and elderly women did not provide evidence of a positive association between glycemic load, glycemic index and carbohydrate intake with risk of stomach cancer.     

Vitamin C intake and breast cancer mortality in a cohort of Swedish women

Background:

Vitamin C may influence cancer progression through its antioxidant properties. However, the evidence from observational epidemiologic studies on vitamin C intake and survival following breast cancer diagnosis is not consistent, and the safety of vitamin C supplements following breast cancer diagnosis has not been extensively studied.

Methods:

Using a food-frequency questionnaire we investigated whether vitamin C intake was associated with survival among 3405 women diagnosed with invasive breast cancer in the Swedish Mammography Cohort.

Results:

From 1987–2010, there were 1055 total deaths with 416 deaths from breast cancer. Women in the highest quartile of pre-diagnosis vitamin C intake had an adjusted HR (95% CI) of breast cancer death of 0.75 (0.57–0.99) compared with those in the lowest quartile (P_trend=0.03). There was a borderline significant association between vitamin C intake and total mortality (HR=0.84; 95% CI=0.71–1.00; P_trend=0.08). Among 717 breast cancer cases for whom post-diagnosis supplement use was available, there was no association between vitamin C supplement use (≈1000 mg) and breast cancer-specific mortality (HR=1.06; 95% CI=0.52–2.17).

Conclusion:

Our findings suggest that dietary vitamin C intake before breast cancer diagnosis may be associated with breast cancer survival. In addition, post-diagnosis vitamin C supplementation at the level observed in our population was not associated with survival.     

Dietary intake of flavonoids and oesophageal and gastric cancer: incidence and survival in the United States of America (USA)

Background:

Flavonoids, polyphenolic compounds concentrated in fruits and vegetables, have experimentally demonstrated chemopreventive effects against oesophageal and gastric cancer. Few epidemiologic studies have examined flavonoid intake and incidence of these cancers, and none have considered survival.

Methods:

In this USA multicentre population-based study, case participants (diagnosed during 1993–1995 with oesophageal adenocarcinoma (OEA, n=274), gastric cardia adenocarcinoma (GCA, n=248), oesophageal squamous cell carcinoma (OES, n=191), and other gastric adenocarcinoma (OGA, n=341)) and frequency-matched controls (n=662) were interviewed. Food frequency questionnaire responses were linked with USDA Flavonoid Databases and available literature for six flavonoid classes and lignans. Case participants were followed until 2000 for vital status. Multivariable-adjusted odds ratios (ORs) and hazard ratios (HRs) (95% confidence intervals (CIs)) were estimated, comparing highest with lowest intake quartiles, using polytomous logistic and proportional hazards regressions, respectively.

Results:

Little or no consistent association was found for total flavonoid intake (main population sources: black tea, orange/grapefruit juice, and wine) and incidence or survival for any tumour type. Intake of anthocyanidins, common in wine and fruit juice, was associated with a 57% reduction in the risk of incident OEA (OR=0.43, 95% CI=0.29–0.66) and OES (OR=0.43, 95% CI=0.26–0.70). The ORs for isoflavones, for which coffee was the main source, were increased for all tumours, except OES. Anthocyanidins were associated with decreased risk of mortality for GCA (HR=0.63, 95% CI=0.42–0.95) and modestly for OEA (HR=0.87, 95% CI=0.60–1.26), but CIs were wide.

Conclusions:

Our findings, if confirmed, suggest that increased dietary anthocyanidin intake may reduce incidence and improve survival for these cancers.     

胃肝样腺癌临床病理分析

目的：探讨胃肝样腺癌（hapatoid adenocarcinoma of the stomach, HAS）的病理学特点及临床诊断和治疗。方法：分析201002—01—2011—12-31绍兴市人民医院收治的6例经手术及病理确诊的HAS患者的临床和病理资料。结果：肿瘤位于胃窦部3例,胃体部1例,胃底及贲门部2倒。病理类型,溃疡型3例,蕈伞型1例,弥漫浸润型2例。组织学检查显示,6例均为进展期胃癌,癌组织已侵及肌层或全层。肿瘤分为腺癌区和肝样分化区。6例患者均有淋巴结转移,转移度为28．97％（42／145）。免疫组化检测显示,6例HAS中AFP、ACT和AAT表达均为阳性,4例CEA表达阳性,3例p53表达阳性。随访截止2012—08,6例患者随访时间分别为6、10、15、16、21和29个月,平均随访时间16个月。至随访结束6例患者生存时间分别为6、10、15、16、21和29个月。结论：肝细胞样分化的病理形态特征是胃肝样腺癌的诊断依据,AFP的检测有助于胃肝样腺癌的诊断,常伴有肝和淋巴结转移,预后较其他胃腺癌差。     

Hepatoid adenocarcinoma of the stomach

Received: January 9, 2001 / Accepted: March 13, 2001     

Intake of specific carotenoids and flavonoids and the risk of gastric cancer in Spain

Objectives: To investigate the relationship between gastric cancer and the intake of specific carotenoids (- carotene, -carotene, lutein, and lycopene) and flavonoids (quercetin, kaempferol, myricetin, and luteolin) using new data on their concentration in foods.Methods: Case-control study carried out in Spain that included 354 cases of gastric cancer and 354 controls, matched by age, gender, area of residence and hospital. Usual food intake was assessed using a dietary history questionnaire.Results: In a multivariate model adjusted for several dietary factors, no association was found between intake of any of the studied carotenoids and the risk of gastric cancer. The adjusted OR of gastric cancer for the highest quartile of total flavonoid intake versus the lowest quartile was 0.44 (95 percent confidence interval [CI]=0.25–0.78; p for trend=0.003). Kaempferol intake was found to be protective (OR=0.48; CI=0.26–0.88; p for trend=0.04) comparing the highest versus the lowest quartile of intake. A trend toward lower risk of stomach cancer with higher intake of quercetin was also found.Conclusions: The results of this study support the hypothesis that the well-established protective effect of fruit and vegetables against gastric cancer could, in part, be due to the presence of flavonoids.