CAJ | 학술논문

目的：胃原发性绒毛膜癌（primary gastric choriocarcinoma，PGC）少见，汇总分析国内报道的病例，探讨PGC的临床病理特点及诊治策略。方法：报道本院2例患者，同时以“胃原发性绒毛膜癌”、“胃绒毛膜癌”、“异位绒毛膜癌”为检索词，电子检索中国生物医学期刊文献数据库和中国生物医学文献数据库，总结分析纳入文献的临床资料。结果：纳入14篇文献，结合本院2例患者，共报道PGC患者16例，男性12例，女性4例，发病年龄42～79岁，平均年龄57.69岁；临床表现主要为腹部不适（12例）；11例患者肿瘤标志物检测，HCG-β均升高；13例患者可见器官或淋巴结转移，6例患者可见2个或2个以上器官转移，转移主要器官为肝、胃周淋巴结、肺、脑、腹腔；PGC以溃疡型为主，12例表现为溃疡，伴坏死、出血，4例表现为肿物，病变可发生在胃小弯（5例），胃窦（6例），贲门（2例），胃体（3例）；PGC在组织学上常与多种肿瘤成份共同存在，其中合并腺癌7例，腺、鳞癌2例，腺癌及印戒细胞癌1例，6例为单纯的绒毛膜癌成分；手术切除联合化疗是PGC的主要治疗方法，14例患者经历了手术治疗，7例患者手术后行全身化疗，1例患者行单纯化疗；10例患者进行随访，8例患者在确诊后6个月内死亡。结论：PGC是一种罕见的胃恶性肿瘤，多发于老年男性，临床表现无特异性，HCG-β均升高，病理检查可确诊，早期以手术切除联合化疗为首选，晚期患者以全身化疗为主，预后极差。
목적：위원발성융모막암（primary gastric choriocarcinoma，PGC）소견，회총분석국내보도적병례，탐토PGC적림상병리특점급진치책략。방법：보도본원2례환자，동시이“위원발성융모막암”、“위융모막암”、“이위융모막암”위검색사，전자검색중국생물의학기간문헌수거고화중국생물의학문헌수거고，총결분석납입문헌적림상자료。결과：납입14편문헌，결합본원2례환자，공보도PGC환자16례，남성12례，녀성4례，발병년령42～79세，평균년령57.69세；림상표현주요위복부불괄（12례）；11례환자종류표지물검측，HCG-β균승고；13례환자가견기관혹림파결전이，6례환자가견2개혹2개이상기관전이，전이주요기관위간、위주림파결、폐、뇌、복강；PGC이궤양형위주，12례표현위궤양，반배사、출혈，4례표현위종물，병변가발생재위소만（5례），위두（6례），분문（2례），위체（3례）；PGC재조직학상상여다충종류성빈공동존재，기중합병선암7례，선、린암2례，선암급인계세포암1례，6례위단순적융모막암성분；수술절제연합화료시PGC적주요치료방법，14례환자경력료수술치료，7례환자수술후행전신화료，1례환자행단순화료；10례환자진행수방，8례환자재학진후6개월내사망。결론：PGC시일충한견적위악성종류，다발우노년남성，림상표현무특이성，HCG-β균승고，병리검사가학진，조기이수술절제연합화료위수선，만기환자이전신화료위주，예후겁차。
Objective:Primary gastric choriocarcinoma (PGC) is a rare tumor. This study aimed to analyze cases reported in Chi-nese and two cases in our hospital. This study was also conducted to investigate the clinical characteristics and treatment of PGC. Meth-ods:The Chinese Medical Current Contents and China Biology Medicine database was retrieved with the following terms:primary gas-tric choriocarcinoma, stomach choriocarcinoma, and ectopic choriocarcinoma. The clinical data in published literature were retrospec-tively analyzed. Two cases from our hospital were also retrospectively analyzed. Results:A total of 16 patients with PGC (14 case stud-ies and 2 cases from our hospital) were included in this study. The average age of the patients was 57.69 years (ranging from 42 years to 79 years). Among the 16 patients, 4 were females and 12 were males. The main clinical manifestation was abdominal discomfort (12/16). Laboratory and imaging tests were non-specific, but HCG-βin all of the patients increased (11/11). Organ or lymph node metasta-sis was found in 13 patients, including 6 cases in which two or more organs showed metastasis. These organs were primarily the liver, the stomach lymph nodes, the lungs, the brain, and the abdominal cavity. Pathological examination results showed that 12 of the 16 cas-es displayed ulcers with necrosis and hemorrhage. The four remaining cases manifested lesions. Lesions may occur in the stomach less-er curvature (5 cases), stomach sinus (6 cases), cardiac (2 cases), and gastric body (3 cases). The histological components of PGC co-ex-isted with other factors, such as adenocarcinoma (7 cases), adenocarcinoma and squamous (2 cases), adenocarcinoma and a signet ring cell (1 case), or pure choriocarcinoma (6 cases). Surgery combined with chemotherapy was the main treatment. A total of 14 patients un-derwent surgical operations. Among these patients seven underwent chemotherapy after surgery and one underwent chemotherapy. Among the 10 patients who were followed up, 8 died within six months after diagnosis. Conclusion:PGC is a rare stomach cancer with poor prognosis and primarily affects older men. No characteristic clinical manifestations were observed, but HCG-βas a specific serum tumor biomarker increased in all of the affected patients. Histological components co-existed with other stomach cancers. Surgical exci-sion combined with chemotherapy was the preferred treatment in early stages, and systemic chemotherapy was the recommended treat-ment in advanced stages.