35岁以下胃癌患者380例临床分析

目的总结35岁以下胃癌患者的临床特点。方法对380例35岁以下胃癌患者的临床资料进行回顾性分析。结果本组病例占同时期胃癌患者的3.4%。病理分类中以弥漫型胃癌多见(65.8%);肿瘤的TNM分期中Ⅳ期病例占53.7%,进展期胃癌占94.7%(360/380);手术切除率68.2%,根治切除率32.4%,姑息手术率35.8%。只有20例(7.2%)生存超过6年。预后因素分析表明,肿瘤位置、肿瘤病理分期、肿瘤的浸润/转移以及是否行根治术是影响预后的主要因素。结论35岁以下胃癌患者以弥漫型、进展期癌占多数,手术切除率低,预后差。     

不同病理类型进展期胃癌的预后因素分析

目的探讨不同病理类型进展期胃癌患者的临床病理特征及预后因素。方法回顾性分析2011年间在南京大学医学院附属鼓楼医院集团宿迁市人民医院行胃癌根治术的98例进展期胃癌患者的临床病理资料,其中胃腺癌53例,胃黏液腺癌30例,胃印戒细胞癌15例,比较不同病理类型进展期胃癌患者的临床病理特征及预后的差异。结果 (1)3种不同病理类型进展期胃癌患者的性别、年龄、神经侵犯及分化程度比较差异无统计学意义(P0.05),而其肿瘤直径、肿瘤位置、手术根治类型、区域淋巴结转移、淋巴管癌栓、侵犯深度及p TNM分期比较差异有统计学意义(P0.05)。(2)单因素分析结果显示,胃腺癌患者的预后与肿瘤直径、肿瘤位置、手术根治类型、区域淋巴结转移、侵犯深度及p TNM分期有关(P0.05),胃黏液腺癌患者的预后与手术根治类型、区域淋巴结转移及p TNM分期有关(P0.05),胃印戒细胞癌患者的预后与区域淋巴结转移、侵犯深度及p TNM分期有关(P0.05)。(3)将与3种不同病理类型进展期胃癌患者预后有关的因素进一步行Cox多因素分析,结果显示,肿瘤位置(P=0.016)、区域淋巴结转移(P=0.042)、侵犯深度(P=0.021)及p TNM分期(P=0.009)是影响胃腺癌患者预后的独立危险因素,区域淋巴结转移是影响胃黏液腺癌患者预后的独立危险因素(P=0.000),肿瘤侵犯深度(P=0.032)及区域淋巴结转移(P=0.002)是影响胃印戒细胞癌患者预后的独立危险因素。(4)随访时间60个月,胃腺癌患者的中位随访时间为32个月,胃黏液腺癌患者为43个月,胃印戒细胞癌患者为23个月,5年累积生存率胃腺癌患者为30.2%,胃黏液腺癌患者为23.3%,胃印戒细胞癌患者为26.7%。三者生存曲线比较差异无统计学(P=0.131)。结论不同病理类型进展期胃癌患者的临床病理特征有一定的差异,从而影响其预后的因素也不同,但是区域淋巴结转移是影响3种不同病理类型进展期胃癌患者的共同预后因素。     

青年人胃癌临床病理特点及预后分析

目的 探讨青年人胃癌不同于中老年人胃癌的临床病理特点及预后相关因素.方法 对1980年1月至2000年12月收治的157例青年(≤40岁)与1761例中老年(>40岁)胃癌患者的临床病理资料进行对比分析.结果 组织分化不良、弥漫型生长方式、Borrmann 4型及病变累及全胃者在青年组中均明显高于中老年组(P<0.05),在青年女性组中比例更高.早期胃癌比例在青年组中亦明显高于中老年组(P<0.05),在青年男性组更高.青年男性组中位生存时间为35个月,青年女性组中位生存时间为19个月,两组生存曲线比较差异有统计学意义(P=0.0219);中老年男性组中位生存时间为26个月,中老年女性组中位生存时间为30个月,两组差异无统计学意义(P=0.9958).TNM分期、根治度、大体分型是青年人胃癌预后的独立风险因素.结论 与中老年组相比,青年女性胃癌分化差、病期晚者比例较高,总体预后相对较差;而青年男性胃癌早期比例较高,总体预后相对较好.在各种临床病理因素中,病理分期、能否手术切除及手术根治程度是决定青年人胃癌预后的独立因素.     

40岁以下青年人直肠癌患者的预后因素分析

目的探讨影响青年人直肠癌预后的因素。方法分析一个肿瘤中心10年间经手术治疗的168例40岁以下直肠癌病例的临床病理特征,对影响患者生存的多种因素进行了单因素及多因素分析。结果168例中,病理根治术(R0)130例(77.4%),镜下切端阳性(R1)12例(7.1%),大体标本切端阳性(R2)26例(15.5%)。低位前切除术57例,Miles术89例,单纯行乙状结肠造瘘术22例;手术死亡率为0。随访期间发生肝转移10例,肺转移6例,骨转移1例。81例患者于术后87个月内死于复发和转移。患者的平均生存时间为(67.0±3.8)个月。5年和10年总生存率分别为44.3%及37.0%。单因素分析表明,术式、肿瘤根治度、肿瘤病理类型、肿瘤直径、肿瘤侵犯深度、淋巴结转移、远处转移、肝转移及TNM分期为影响预后的因素;多因素回归分析显示,仅有肿瘤根治度及淋巴结转移是影响患者术后生存的独立因素。结论影响直肠癌患者术后生存的因素为术式、肿瘤的根治度、病理类型、肿瘤直径、肿瘤侵犯深度、淋巴结转移、远处转移、肝转移及TNM分期。其中独立影响因素仅有肿瘤的根治度及淋巴结转移。     

进展期胃癌术前靶向磁化疗的临床研究

目的 观察进展期胃癌术前应用抗癌药物阿霉素磁联合外磁场靶向磁化疗的临床及病理组织学疗效。方法 进展期胃癌１４５例分为靶向磁化疗组（７５例）,非靶向化疗组（４０例）及单纯手术组（３０例）,观察治疗后中组患临床症状、肿瘤手术切除率、生存率以及肿瘤标本的病理组织学改变。结果 靶向磁化疗组可明显改善患症状,增加肿瘤及区域淋巴结中抗癌药物浓度及持续时间,肿瘤手术切除率为７７．３％,再次手术切除率达１５．     

不同部位可根治性胃癌病理特征外科处理方式及预后因素比较

目的 比较不同部位可根治性胃癌的病理特征、外科处理方式及预后影响因素。 方法 中山大学附属第一医院胃肠胰外科对1999年8月至2006年3月诊治的356例临床病理数据完整、无远处转移、并接受根治手术的原发性非全胃癌,依肿瘤部位分为胃上部癌(U,96例)、胃中部癌(M, 93例)、胃下部癌(L, 167例) 3组,对其临床病理特征、外科处理方式、预后影响因素进行分析比较。结果 不同部位癌的肿瘤直径、浆膜浸润、淋巴结转移状况、TNM分期、组织分型、术前癌胚抗原（CEA）值等差异无统计学意义(P >0.05)。U、M、L部癌的中位生存期分别为49.0、70.1、70.9个月;U部癌预后差于其他组(P <0.05)。胃癌总体的独立预后因素包括术后病理分期（pTNM）、Borrmann分型、根治方式;U部癌的独立预后因素为pTNM、根治方式;M部癌的独立预后因素为pTNM、Borrmann分型;L部癌的独立预后因素为pTNM、根治方式。结论 不同部位可根治性胃癌的病理特征、预后影响因素不同,外科处理方法应区别对待。     

青年人胃癌的特点

探讨青年人胃癌的生物学特点,评价不同手术方法与预后的关系。方法对８９例青年人胃癌患者的临床特点,治疗方法及预后进行了回顾性分析。结果本组患者肿瘤切除率７３．０％,其中根治切除率４８．３％,姑息性切除率２４．７％;５年生存率２４．７％,其中胃癌根治术后５年生存率为４８．８％。     

56例青年人胃癌临床病理及其生存分析

【摘要】 目的 探讨青年人胃癌的临床病理特点及预后。方法 回顾性分析2005年1月至2010年12月初治的56例青年人胃癌（年龄≤40岁）的临床资料,并随机选取同期56例老年人胃癌（年龄≥60岁）作对照。采用SPSS13.0统计软件分析青年人胃癌的临床病理特点及与预后的关系。结果 56例青年人胃癌女性比例高于男性（χ2 =11.593,P=0.001）;肿瘤多位于胃窦部;病理类型以低分化腺癌和未分化癌为主,高于对照组（χ2 =16.586,P＜0.001）;临床分期以中晚期多见;术后生存中位时间为39.56个月,1、3、5 年生存率分别为80.0%、52.0%、24.0%;行根治性手术患者生存率高于姑息性手术患者（χ2 =5.836,P=0.016）;手术方式、肿瘤大小、病理类型、临床分期是影响青年人胃癌预后的主要因素(P＜0.05)。结论 青年人胃癌以女性居多,起病隐匿,确诊多为中晚期,恶性程度高,应重视青年人胃癌的早期诊断,尽早行根治性手术,有助于改善患者预后。     

放疗在弥漫型胃癌综合治疗中的应用研究进展

弥漫型胃癌发病率呈逐年增高趋势,以手术治疗为主的综合治疗是目前的主要方式,恶性程度高,手术切除率低,手术治疗失败的主要原因是局部复发,预后极差.放疗是弥漫型胃癌综合治疗的重要组成部分,术前可降低肿瘤分期,术后可防止复发转移,有效的新辅助放疗是提高弥漫型胃癌患者手术切除率的途径之一.本文综述了弥漫型胃癌的放疗临床应用进展...     

进展期胃癌术前靶向磁化疗的临床研究

目的观察进展期胃癌术前应用抗癌药物阿霉素磁液联合外磁场靶向磁化疗的临床及病理组织学疗效 .方法进展期胃癌 145例分为靶向磁化疗组 (75例 ),非靶向化疗组 (40例 )及单纯手术组 (30例 ),观察治疗后各组患者临床症状、肿瘤手术切除率、生存率以及肿瘤标本的病理组织学改变 .结果靶向磁化疗组可明显改善患者症状 ,增加肿瘤及区域淋巴结中抗癌药物浓度及持续时间 ,肿瘤手术切除率为 77 3% ,再次手术切除率达 15 0% ,肿瘤及转移淋巴结病理组织学疗效分别达 78 3%和 57 5% ,术后短期生存率有所提高 .结论进展期胃癌术前应用阿霉素磁液联合磁场的靶向磁化疗具有一定的临床意义 .     

Gastric resection in the aged (> or = 80 years) with gastric carcinoma: a multivariate analysis of prognostic factors

BACKGROUND: The incidence of gastric neoplasm is increasing in the elderly population. Therefore, a rational method of treatment for gastric cancer in the elderly should be constituted to improve the survival. The purpose of the present study was to clarify whether the patient's age is an independent prognostic factor and to determine clinicopathological characteristics in the elderly. METHODS: Curative resection of gastric cancer was carried out on 601 patients who were 40 years or older. They were divided into the following two groups: younger patients (between 40 and 79 years old) and elderly patients (80 years or older). The clinicopathologic features of these patients were reviewed retrospectively and multivariate analysis was carried out. RESULTS: The distinguishing features of gastric cancer in the elderly patients were intestinal and mixed types of cancer, distal third stomach dominance in the tumour location, advanced stage of disease, and a low rate of extensive lymph node dissection (D3 or more). Regarding the recurrence site, the liver was the dominant site in the elderly group (25.3% in the younger group vs 54.5% in the elderly group). The 10-year disease-free survival rate of the elderly group was 53.2%, which was significantly worse than that (79.9%) of the younger patients (P = 0.0004). In multivariate analysis, an age of > or = 80 years is an independent prognostic factor, as well as stage, depth of tumour invasion, lymph node metastasis, scirrhous carcinoma, and blood transfusion. CONCLUSIONS: Results indicate that gastric cancer in elderly patients has a poorer prognosis than that in younger patients.     

Gastric resection in the aged (≥ 80 years) with gastric carcinoma: a multivariate analysis of prognostic factors

Background : The incidence of gastric neoplasm is increasing in the elderly population. Therefore, a rational method of treatment for gastric cancer in the elderly should be constituted to improve the survival. The purpose of the present study was to clarify whether the patient’s age is an independent prognostic factor and to determine clinicopathological characteristics in the elderly. Methods : Curative resection of gastric cancer was carried out on 601 patients who were 40 years or older. They were divided into the following two groups: younger patients (between 40 and 79 years old) and elderly patients (80 years or older). The clinicopathologic features of these patients were reviewed retrospectively and multivariate analysis was carried out. Results : The distinguishing features of gastric cancer in the elderly patients were intestinal and mixed types of cancer, distal third stomach dominancy in the tumour location, advanced stage of disease, and a low rate of extensive lymph node dissection (D3 or more). Regarding the recurrence site, the liver was the dominant site in the elderly group (25.3% in the younger group vs 54.5% in the elderly group). The 10‐year disease‐free survival rate of the elderly group was 53.2%, which was significantly worse than that (79.9%) of the younger patients (P = 0.0004). In multivariate analysis, an age of ≥ 80 years is an independent prognostic factor, as well as stage, depth of tumour invasion, lymph node metastasis, scirrhous carcinoma, and blood transfusion. Conclusions : Results indicate that gastric cancer in elderly patients has a poorer prognosis than that in younger patients.     

Comparison between treatment results for gastric cancer in younger and elderly patients

INTRODUCTION: While gastric cancer shows an increased incidence in elderly patients, the rate of younger patients affected by this disease represents up to 15 %. Younger patients are frequently diagnosed with advanced tumor stages with a poor prognosis although literature data on this issue are controversial. PATIENTS AND METHODS: 643 patients with primary gastric carcinoma were operated in our institution between March 1986 and December 2000. No neoadjuvant treatment was administered in these patients. We analysed the data of these patients retrospectively. A comparison of the results between patients younger than 40 years (n = 38, median age 37 years) and older than 70 years (n = 182, median age 75 years) was performed. RESULTS: The radical (R0-) resectability rate was rather high for both, younger (78.9 %) and elderly (76.9 %) patients. Postoperative morbidity was higher in elderly than in younger patients (32.9 % vs. 23.2 %; p < 0.05), as well as the postoperative mortality (7.7 % vs. 2.6 %; p < 0.05). Both younger and elderly patients showed advanced (II to IV) tumor stages (76.3 % vs. 73.3 %, n. s.). There was a significant difference between the rate of diffuse carcinomas in young and elderly patients (63.2 % vs. 22.5 %). The 5-years survival rate following R0-resection was significantly higher for younger patients (54.2 % vs. 32.9 %; p = 0.01), differences occurred only after the second postoperative year. CONCLUSIONS: The resectability of gastric carcinoma is not related to the patients age. Due to comorbidity, postoperative morbidity may be increased in elderly patients. Although both younger and elderly patients show advanced tumor stages, diffuse carcinomas are more frequent in younger patients. The short-term prognosis is similar for both age groups, long-term results are better for younger patients. The different life expectancy should be considered when interpreting these results.     

Clinicopathological features of gastric carcinoma in younger and middle-aged patients: A comparative study

Gastric carcinoma is relatively rare in patients under the age of 40. This study was undertaken to clarify the clinicopathological characteristics and surgical outcomes of gastric carcinoma in younger patients compared with those of middle-aged patients. The surgical results from 131 younger patients (aged ⩽40 years) and 918 middle-aged patients (aged 55–65 years) were compared retrospectively. Female gender, undifferentiated tumor type and lymphatic invasion were significantly more common in the younger patients. Survival time did not differ between the two groups. The depth of tumor invasion was the only prognostic factor in younger patients, whereas macroscopic appearance, tumor diameter, depth of invasion, lymph node metastasis, and venous invasion were all significant prognostic factors in middle-aged patients. Peritoneal recurrence was significantly more common in younger patients. A family history of gastric adenocarcinoma was observed in 25.9% of younger patients, but this did not affect survival outcomes. As depth of invasion affects prognosis independently, and peritoneal metastasis is the predominant pattern of recurrence, it is essential to establish an optimal prophylactic treatment for peritoneal metastasis to improve surgical outcomes in younger patients with advanced gastric cancer.     

Borrmann's type IV gastric cancer: clinicopathologic analysis.

OBJECTIVE: To determine whether there is a specific pattern of clinicopathological features that could distinguish Borrmann's type IV gastric cancer from other types of gastric cancer. DESIGN: A retrospective study of patients with advanced gastric cancer treated between 1985 and 1995. SETTING: The Department of Surgery, Sendai National Hospital, a 716-bed teaching hospital. PATIENTS: The clinicopathologic features of 88 patients with Borrmann's type IV carcinoma of the stomach were reviewed from the database of gastric cancer. The results were compared with those of 309 patients with other types of gastric carcinoma. MAIN OUTCOME MEASURES: Gender, age, tumour size, depth of invasion, histologic type, cancer-stromal relationship, histologic growth pattern, nodal involvement, lymphatic and vascular invasion, type of operation, cause of death and 5-year survival. RESULTS: Women were afflicted as commonly as men in the Borrmann's type IV group. These patients tended to be younger and to have larger tumours involving the entire stomach than patients with other types of cancer. Histologic type was commonly diffuse and scirrhous, and serosal invasion was prominent with infiltrative growth. Nodal involvement and lymphatic invasion were more common in patients with Borrmann's type IV than in those with other types of gastric cancer. The disease was advanced in most instances and a total gastrectomy was performed in 55% of the patients. The survival rate of patients with Borrmann's type IV tumour was lower than for patients with other types of gastric cancer (p < 0.005, log-rank test). CONCLUSIONS: In Borrmann's type IV gastric cancer, early detection and curative resection are crucial to extend the patient's survival. Aggressive postoperative chemotherapy is recommended when a noncurative resection is performed.     

青年胃癌患者临床病理特征和预后分析

目的 探讨青年胃癌患者的临床病理特征及其预后影响因素.方法 回顾性收集中山大学附属第一医院2001年8月至2009年12月期间收治的99例青年胃癌患者(年龄小于或等于40岁)的临床病理资料,并与同时期收治的40岁以上的894例中老年胃癌患者的临床病理特征及预后进行对比分析.结果 与中老年组比较,青年组胃癌患者以女性多见,更易累及全胃,BorrmannⅣ型和印戒细胞癌的比例更高,分化程度更低,浸润程度更深,更易出现腹膜转移(均P＜0.05).青年组和中老年组胃癌患者5年生存率分别为49.1％和44.4％,差异无统计学意义(P＞0.05).单因素和多因素预后分析显示,TNM分期(P=0.014)和手术方式(P=0.012)是青年胃癌患者的独立预后因素.青年胃癌患者行根治性手术后5年生存率为56.7％,姑息性切除术后5年生存率为11.1％,而行姑息性减状术以及探查或活检手术者均于术后1年内死亡;不同手术方式患者术后生存率的比较差异有统计学意义(P＜0.05).结论 青年胃癌患者有其特殊的临床病理特征,但预后与中老年患者无异;TNM分期和手术方式是影响青年胃癌患者预后的独立因素,根治性手术是获得长期疗效的唯一方法.     

Colorectal cancer in a patient younger than 20 years of age: Report of a case and a review of the Japanese literature

This article presents a case of advanced cancer of the transverse colon seen in an 18-year-old woman who underwent a potentially curative resection. The histological type of cancer was well-differentiated adenocarcinoma. After reviewing the clinicopathological features of 110 colorectal cancer cases in patients younger than 20 years of age compiled from the Japanese literature, the high incidence of poorly differentiated carcinoma (51.5% for poorly differentiated adeno-carcinoma, signet-ring cell carcinoma, mucinous carcinoma, and undifferentiated carcinoma) and of more advanced stages (67.1% for clinical stages IIIb and IV) were found to be characteristic for patients with colorectal cancer younger than 20 years of age. The presence of more advanced disease and the high incidence of poorly differentiated carcinoma thus seem to be related to the low postoperative survival rates. The 2-year survival rate was 19.8% and the 5-year survival rate was 8.8% in colorectal cancer patients younger than 20 years of age.     

Clinicopathological features and prognosis of gastric cancer in young European adults

BACKGROUND: The aims of this study were to define the clinicopathological features and prognosis of gastric cancer in young European adults. METHODS: Between 1990 and 2004, 603 patients with gastric cancer were enrolled in a prospective database. The findings for 51 (8.5 per cent) patients aged 45 years or less were compared with those of 457 aged between 46 and 75 years. RESULTS: In the younger group there were significantly more women (57 versus 36.3 per cent; P = 0.004), Laurén diffuse-type carcinomas (73 versus 42.7 per cent; P < 0.001), N2-3 lymph node metastases (59 versus 38.9 per cent; P = 0.005), stage IV disease (49 versus 35.7 per cent; P = 0.085) and resections that were non-curative (36 versus 18.5 per cent; P = 0.007) than in the older patients. Actuarial survival rates in younger patients at 5 and 10 years after resection were 40 and 32 per cent respectively, similar to those in older patients (P = 0.540). Unfavourable prognostic factors associated with poor 5-year survival were the degree of gastric wall invasion (T3-4 versus T1-2; P < 0.001), lymph node invasion (positive versus negative; P < 0.001), disease stage (III-IV versus I-II; P < 0.001) and curability of resection (non-curative versus curative; P < 0.001). CONCLUSION: Gastric cancer in young adults tends to be more advanced; however, when matched for stage, the prognosis does not differ from that of older patients.     

Ⅲ期胃癌患者的临床病理特征及预后分析

目的 探讨Ⅲ期胃癌（按第7版TNM分期标准）的临床病理特征及影响预后的相关因素.方法 回顾性分析1991年1月至2005年12月间中国医科大学附属第一医院收治的经外科切除治疗的1007例Ⅲ期胃癌患者的临床病理和随访资料.分别采用Log-rank检验和Cox比例风险模型对Ⅲ期胃癌患者的预后进行单因素和多因素分析.结果 1007例Ⅲ期胃癌患者的平均年龄为58.7岁,男女比例为2.6∶1.0;ⅢA期242例,ⅢB期403例,ⅢC期362例.手术接受R0切除者754例（74.9％）,R1切除者56例（5.5％）,R2切除者197例（19.6％）;R0切除者5年生存率为37.8％,高于R１切除者（21.2％）和R2切除者（8.9％）,差异有统计学意义（P＜0.05）.多因素分析显示,pN分期、pT分期和Borrmann分型是影响R0切除患者预后的独立因素（均P＜0.01）.结论 Ⅲ期胃癌患者有其自身的临床病理学特点,治疗上应尽可能施行R0根治术.淋巴结转移数目、肿瘤浸润深度和Borrmann分型是影响接受R0手术的Ⅲ期胃癌患者预后的重要因素.     

Borrmann Type IV: An Independent Prognostic Factor for Survival in Gastric Cancer

Background  Borrmann type IV gastric cancer has a poorer prognosis than other gastric carcinomas. This study compared the clinicopathological features of Borrmann type IV gastric cancer with those of other types of cancer and examined the significance of a Borrmann type IV carcinoma as a prognostic factor after gastrectomy. Methods  The clinicopathological features, tumor–node–metastasis (TNM) stage, and survival rates of 4,191 advanced gastric cancer patients, who had undergone a gastrectomy at the Samsung Medical Center between 1995 and 2005, were reviewed. Results  Borrmann type IV gastric cancer was found to be associated with more advanced and unfavorable clinicopathological features at diagnosis than the other cancers. The 5-year survival rate of the patients with Borrmann type IV cancer was 27.6%. In contrast, the 5-year survival rate of patients with the other types of cancer was 61.2%. The 5-year survival rate for each stage of Borrmann type IV gastric cancer and the other type gastric cancer was 61.0% and 88.8% for stage Ib (P < 0.001), 49.8% and 76.1% for stage II (P < 0.001), 36.4% and 55.1% for stage IIIa (P < 0.001), 15.2% and 38.5% for stage IIIb (P = 0.001), and 10.2% and 20.1% for stage IV (P = 0.008), respectively. Multivariate analyses revealed a Borrmann type IV carcinoma, the surgical extent, curability, tumor stage, including T, N, and M status, and adjuvant therapy to be independent prognostic factors for survival. Conclusion  A Borrmann type IV carcinoma has unique clinicopathological features compared with other types of gastric carcinomas and is an important independent prognostic factor.