91例家族性胃癌的临床特点及预后分析

目的：探讨家族性胃癌的临床病理特征及预后，为制定合理的治疗方案提供临床依据。方法回顾性分析天津医科大学肿瘤医院胃部肿瘤科2003年3月至2007年10月收治的91例家族性胃癌患者的临床资料，选取同期293例散发性胃癌患者的临床资料进行对比分析。结果家族性胃癌患者肿瘤直径小于或等于5 cm者所占比例明显高于散发性胃癌患者[65．9％（60/91）比52．6％（154/293），P＝0．025]，低分化者所占比例高于散发性胃癌患者[68．1％（62/91）比55．6％（163/293）， P＝0．034]。家族性胃癌患者术后5年总体生存率明显低于散发性胃癌患者（25．6％比38．9％，P＝0．001）；进一步分层分析，T4期家族性胃癌与散发性胃癌患者5年生存率分别为14．5％和30．5％；N3期患者分别为10．4％和17．3％，差异均有统计学意义（P＜0．05）；两组间其他T分期和N分期5年生存率的差异均无统计学意义（P＞0．05）。单因素分析显示，肿瘤大小、肿瘤部位、病理类型、手术方式、浸润深度和淋巴结转移与家族性胃癌患者预后有关；多因素分析显示，肿瘤大小（HR＝2．271）、病理类型（HR＝1．449）、浸润深度（HR＝1．748）及淋巴结转移（HR＝1．487）是影响家族性胃癌患者预后的独立危险因素。结论与散发性胃癌比较，家族性胃癌患者具有肿瘤分化差和预后不佳的特点。

Analysis of clinicopathological characteristics and prognosis of 91 patients with familial gastric cancer

Objective To explore the clinicopathological characteristics and prognosis of familial gastric cancer （FGC） and to provide clinical evidence for rational treatment program. Methods Clinicopathological data of 91 patients with FGC and 293 patients with sporadic gastric cancer （SGC） in our department from March 2003 to October 2007 were retrospectively analyzed and compared between the two groups. Results Tumors with a diameter of less than or equal to 5 cm were more common in FGC patients than SGC patients [65.9%（60/91） vs. 52.6%（154/293）, P=0.025]. Proportion of FGC patients with poor differentiation was significantly higher as compared to SGC patients [68.1%（62/91） vs. 55.6%（163/293）, P=0.034]. The 5-year overall survival rate in FGC patients was significantly lower than that in SGC patients （25.6% vs. 38.9%, P=0.001）. Further stratified analysis revealed that the 5-year survival rates of T4 FGC and T4 SGC patients were 14.5% and 30.5% respectively, the 5-year survival rates of N3 FGC and N3 SGC patients were 10.4%and 17.3%respectively, and the differences were statistically significant（all P〈0.05）, while other T stage and N stage between the two groups were not significantly different（all P〉0.05）. Univarite analysis showed that tumor size, tumor location, pathological type, operation method, infiltration depth and lymph node metastasis were influencing factors of prognosis of FGC. Multivariate analysis showed that tumor size （HR=2.271）, pathology types （HR=1.449）, lymph node metastasis （HR=1.748） and the infiltration depth （HR=1.487） were independent risk factors affecting the prognosis of patients with FGC. Conclusion Compared with SGC, FGC is associated with poor differentiation and poor prognosis.