青年人与老年人胃癌临床病理及预后对比分析

目的探讨青年与老年胃癌的临床、内镜、术后病理特点及预后。方法回顾性总结我院2003年12月～2012年12月经胃镜检查,手术确诊的青年人(≤35岁)胃癌51例及老年人(≥65岁)胃癌284例,进行临床表现、内镜表现、术后病理分型及预后等对比分析。结果近年来,胃癌患病总人数下降,同期内老年人胃癌总人数多于青年人;青年组胃癌以女性多,老年组以男性多;青年组多在胃下1/3,老年组多在胃上1/3;内镜下青年组多表现为Borrmann Ⅲ、Borrmann Ⅳ,术后病理以低分化腺癌、黏液腺癌、印戒细胞癌为主;老年组以Borrmann Ⅰ、Borrmann Ⅲ为主,术后以高-中分化腺癌居多;两组胃癌手术方式无差异性;老年组1年、3年生存率高于青年组。结论青年人胃癌临床症状隐匿,病理分化差,预后差。早期胃镜检查、定期复查、幽门螺杆菌根除、手术是青年人胃癌治疗的关键。

Comparative analysis of young and old patients with clinical pathological features and prognosis of gastric cancer

Purpose To investigate the characteristics and differences of gastric cancer between old patients and young patients in the clinical manifestation, treatment and prognosis. Methods Fifty-one young patients（≤35 years old） with gastric cancer from December, 2003 to December, 2012 were retrospectively analyzed, and compared with 284 elderly （≥65 years old） patients with gastric cancer according to clinical and pathological data. Results Young gastric cancer accounts for 6.9% of all gastric cancer patients during the study period. Detectable rate of young female gastric cancer was higher than male. The symptoms of young patients with gastric cancer were not typical. The antral gastric cancer was not rare, and cardiac cancer was common in eldly group. Most of them were found at progressive stage. Ulcerated infiltrating types were the most common type, with early metastasis. Poorly differentiated adenocarcinoma and signet ring cell carcinoma were common in young group. There were more cases with well and moderately differentiated adenocarcinoma in eldly group which were mainly Borrmann Type Ⅰ and Ⅲ. Helicobacter pylori infection, dietary habits, family enviroment were related to young gastric cancer. There was no significant difference between radical resection rate and resection rate between two groups. However, 1-year and 3-year survival rate were lower in young group than eldly group. Conclusion The prognosis of young patients with gastric cancer was poor,therefore, the early diagnosis and treatment must be strengthened.