胃黏液腺癌与胃印戒细胞癌的临床病理特征及预后的分析比较

Comparison of clinicopathologic characteristics and prognosis between gastric mucinous cancer and gastric signet ring cell cancer

目的比较胃黏液腺癌(mucinous gastric carcinoma,MGC)与胃印戒细胞癌(gastricsignet ring cell carcinoma,SRC)临床病理特征的差异,并分析其预后。方法回顾性分析1994～2006年我科收治的1016例连续胃癌病例的临床病理资料,分析比较MGC与SRC间临床病理特点及预后因素的差异。结果胃癌病例中,MGC占胃癌的6.8%(68例),SRC占9.1%(92例)。MGC与SRC两组相比,在年龄分组、浸润深度、远处转移、接受根治手术、临床TNM分期,两组比较差异有统计学意义(P<0.05);在男女性别比、肿瘤大小、肿瘤部位、Borrmann分型、、淋巴结转移、腹膜转移、肝转移方面,两组无显著性差异(P>0.05)。MGC的总体5年生存率为29.4%,而SRC则为37.3%,MGC的总体生存率较SRC低,但差异未达统计学意义(P>0.05)。当伴淋巴结转移、腹膜转移或Borrmann Ⅲ型时,MGC患者的总体生存率低于SRC患者(P<0.05)。Cox多因素回归分析显示,肝转移、淋巴结转移及根治手术是MGC的独立预后因素;而Borrmann分型、TNM分期及根治手术是SRC的独立预后因素。结论 MGC与SRC比较,MGC在年龄、浸润深度、远处转移、根治手术及TNM分期临床病理方面表现差,MGC5年总体生存率较SRC低,但差异无统计学意义,可能为更多的临床病理因素综合作用所致。

Objective To compare the clinicopathological characteristics between mucinous gastric carcinoma(MGC) and gastric signet ring cell carcinoma(SRC),and analyze prognostic factors.Methods Clinical data of 1016 consecutive gastric cancer patients treated in our hospital from 1994 to 2006 were analyzed retrospectively,clinicopathological characteristics and prognostic factors were compared between MGC and SRC patients.Results Among the all gastric cancer patients,there were 68(6.8%) MGC and 92(9.1%) SRC patients.There were significant differences in the proportions of age group,invasion depth,distant metastasis,radical resection,and TNM stage(P<0.05),but not in male to female ratio,tumor size,tumor location,Borrmann types,lymph node metastasis,peritoneal seeding,hepatic metastasis between MGC and SRC patients.The overall cumulative 5-year survival rates of MGC and SRC patients were 29.4% and 37.3% respectively,but no significant difference was found(P>0.05).Stratification analysis revealed that the survival rates of MGC patients with lymph node metastasis,peritoneal seeding,and Borrmann Ⅲ type,were significantly higher than those of SRC patients.Multivariate analysis showed that liver metastasis,lymph node metastasis and curative resection were independent prognostic factors of MGC patients,while Borrmann types,TNM stage and curative resection were independent prognostic factors of SRC patients.Conclusions Compared with SRC patients,higher proportion of senile patients,distant metastasis,advanced TNM stages,and lower curative resection rate are characteristic in MGC patients.The prognosis of MGC patients is poorer than that of SRC patients,but no significant difference can be found,probably because that other important clinicopathological parameters comprehensively affect the prognosis.