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.

Clinicopathological features and prognosis of young patients with gastric cancer

Objective To summarize the clinicopathological characteristics and analyze the prognostic factors of young patients with gastric cancer. Methods A total of 99 patients with the age less than or equal to 40 were admitted in The First Affiliated Hospital of Sun Yat-sen University from August 2001 to December 2009. Their clinicopathological and follow-up data were compared with middle-aged and elderly patients with the age more than 40. Results There were statistically significant differences in gender, tumor location, Borrmann type, histological type, differentiated histology, depth of invasion, peritoneal metastasis between young patients and elder ones. The 5-year survival rates of young and elder patients were 49.1% and 44.4% respectively, and the difference was not statistically significant （P〉0.05）. Univariate and multivariate analyses showed that TNM stage（P=0.014） and surgical methods（P=0.012） were independent predictive factors of survival for young patients. For the young patients, the 5-year survival rate was 56.7% after curative resection, 11.1% after palliative resection. Those who underwent palliative surgery or biopsy alone died within 1 year after surgery. The difference between difference surgical procedures in survival were statistically significant （P〈0.05）. Conclusions As compared to elder patients, young patients with gastric cancer have special clinicopathological features. However, no significant difference of survival rate is found between the young and the elder patients. TNM stage and surgical methods are independent prognostic factors of young patients with gastric cancer. Radical resection appears to confer the only chance of prolonged survival.