青年胃癌269例分析

目的:分析青年胃癌(≤45岁)的发病特点、病理类型和临床特征,为青年胃癌的预防和治疗提供理论依据。方法:采用胃癌数据库对22年间2158例胃癌资料数据进行筛选和研究,并对青年胃癌的发病特征、病理学情况和临床特征进行统计学分析。结果:青年胃癌以高度恶性弥漫型为主,好发部位为胃窦部和胃体胃角部。男女性比例接近,女性发病年龄低于男性,受遗传因素影响明显,男性更易累及。青年胃癌缺乏特异症状和体征,首次就诊至确诊时间平均为8.7个月,误漏诊率高达65.4%。经胃镜和X线钡餐诊断为胃癌的占66.5%,诊断时进展期占96.7%,仅31.9%可行根治性手术治疗,随访的193例患者2年生存率仅17.1%。结论:青年胃癌以高度恶性弥漫型为主,与遗传关系密切。青年胃癌误漏诊率高,确诊时多为进展期,预后差,临床上应提高警惕,特别是对于具有家族背景的高危人群、出现警惕症状者和病程较长的青年患者,应行X线钡餐和胃镜检查以排除胃癌。

Incidence and pathological characteristics of 269 young patients with gastric neoplasms

OBJECTIVE:To analysis the incidence and characteristics of gastric cancer in the young patients, and to explore the possibility to screen and prevent hereditary gastric carcinoma. METHODS: All 2 158 gastric cancer inpatients' data from Feb. 1983 to Feb. 2005 in Xijing hospitals of the Fourth Military Medical University were collected and 269 patients under 45 years old were selected for analysis. The incidence and characteristics including sex, age, pathological type, hereditary background and clinical data were statistically analyzed. RESULTS: The male and female youth had the similar incidence of gastric carcinoma, but those who with a hereditary background had a tendency to develope the disease at a young age and the male had a higher probability according to the data. The pathological type of gastric cancer in most young patients was diffused carcinoma, which had a poor prognosis, and tumor located at sinus ventriculi, body and curvature of stomach in most of patients. The rate of misdiagnosis and missed diagnosis was as higher as 65.4%, no specific symptom or complaint had been found in these patients. They had an average 8.7 month period from the first visit to the final diagnosis, at then 96.7% were in advanced phase and only 31.9% had a chance to get a radical operation. The 2-year survival of 193 patients from them was 17.1%. CONCLUSIONS: The hereditary effect is significant in the young gastric carcinoma patients, most of which are poorly differentiated. Most patients are in advanced phase and have a poor prognosis because of the high rate of misdiagnosis and missed diagnosis. The incidence of young gastric carcinoma shows a correlation to the hereditary factor, which suggests more attention should be paid to those youth exposed in the HGC background, who have a suspected symptom or/and a long course.