Objective: To assess the clinicopathological feature and prognosis of gastric cancer associated with pregnancy in Chinese population. Methods: We collected the clinical features, pathological findings, treatment modalities, the health status of infants and the information of prognosis for ten patients developed gastric cancer associated with pregnancy between 2001 and 2016 in our hospital and the counterpart 12 patients reported in China National Knowledge Internet (CNKI), Wanfang database and China Science and Technology Journal Database. Results: The most common symptoms were nausea and vomiting (n=14). Melena (n=8), abdominal distension (n=7) and abdominal pain (n=6) were also frequent. When considering the complications, gastrointestinal bleeding (n=9), intestinal obstruction (n=3) and gastric perforation (n=2) were common. The vast majority of pathology showed poorly differentiated tumors, poorly differentiated adenocarcinoma (n=14) and signet ring cell carcinoma (n=7). Only one patient was diagnosed at stage Ⅰ. And 17 patients developed metastatic disease of stage Ⅳ. Peritoneum (n=7) and ovary (n=5) were the most common metastasis sites. Three patients received abortion immediately after diagnosis in the first trimester of pregnancy. For the five patients in the second trimester of pregnancy, pregnancy termination was given to three patients. Caesarean section followed by gastrectomy was performed on three patients who were after the third trimester of gestation. Curative resection and palliative operation were carried out on six and five patients respectively. Combined chemotherapy based on oxaliplatin and fluorouracil was the common treatment for the peri-operative patients. For the metastatic gastric caner, platinum in combination with fluorouracil was recommended in the first line condition, irinotecan or raltitrexed were used in the second line treatment. One-year survival rate was 23.1%, and two-years survival was 15.4%. Three patients after R0 resection were alive without relapse over 18 months. Conclusions: The poor prognosis of gastric cancer associated with pregnancy may due to the late stage and the poor pathological type. There still lacks data of the appropriate treatment in these patients. It was demonstrated most patients have no chance of tumor resection due to the late stage. For the metastatic patients, platinum in combination with fluorouracil was recommended in the first line treatment. Irinotecan or raltitrexed were considered the choice for the second line treatment.
目的： 总结妊娠期胃癌的临床病理特点及预后。 方法： 2001—2016年中国医学科学院肿瘤医院收治的妊娠期胃癌患者10例和在中国知网、万方数据电子期刊数据库、维普电子期刊全文数据库检索到的同期妊娠期胃癌患者12例，收集患者的临床特征、病理学特征、TNM分期、治疗策略、胎儿及患者的预后等信息。 结果： 22例患者临床表现主要为恶心呕吐(14例)、黑便(8例)、腹胀(7例)和腹痛(6例)。并发消化道出血9例，肠梗阻3例，胃穿孔2例。低分化腺癌14例，印戒细胞癌7例。分期为Ⅰ期1例，Ⅳ期17例。腹膜转移(7例)和卵巢转移(5例)最为常见。3例于妊娠早期确诊的患者行人工流产手术。5例妊娠中期患者中，3例行引产手术。3例妊娠晚期患者均于确诊后立即行剖宫产手术。6例行胃癌根治性手术，5例行姑息手术。围手术期化疗方案主要为以奥沙利铂及氟尿嘧啶为主的2药或3药方案。晚期患者的一线化疗方案以铂类和氟尿嘧啶类的联合方案为主，二线化疗方案以含伊立替康或雷替曲塞的方案为主。22例妊娠期胃癌患者的1年生存率为23.1%，2年生存率为15.4%。3例接受R0切除的患者生存时间超过18个月。 结论： 组织分化差和分期晚是妊娠期胃癌患者预后差的主要原因。目前妊娠期胃癌尚缺乏有效治疗策略。由于分期晚，多数患者无法手术切除肿瘤。晚期患者的一线化疗方案以铂类和氟尿嘧啶类的联合方案为主，二线化疗方案以含伊立替康或雷替曲塞的方案为主。.
Keywords: Clinical feature; Pregnancy; Prognosis; Stomach neoplasms.