不同年龄段胃癌患者的临床病理特点与预后分析

Comparison of clinicopathological characteristics and prognosis of gastric cancer patients among different age groups

目的探讨不同年龄段胃癌患者的临床病理特点与生存期的差异。方法对1994年6月至2004年3月收治的胃癌患者的临床病理资料与生存情况进行不同年龄段的对比分析。结果658例患者中,男∶女=2.2∶1。全组年龄19～89(平均57.0)岁。按不同年龄段将患者分为4组,A组:小于或等于40岁,71例(10.8%);B组:大于40岁至60岁,281例(42.7%);C组:大于60岁至70岁,205例(31.2%);D组:大于70岁,101例(15.3%)。全组根治性手术切除率为82.8%,随访率95.7%,中位生存期30.3个月,1、3、5年生存率分别为55.3%、40.2%和33.2%。A组的男女比例为1:1.1(34/37),女性所占比例明显高于其他各组(P<0.001);低分化腺癌占90.1%(64/71),明显高于其他各组(P<0.001)。肿瘤部位,各组均以胃下部癌所占比例为最多(35.9%～47.5%);临床分期A组以Ⅲ、Ⅳ期为主(74.6%),B、C组以Ⅲ期为最多(47.3%、45.4%),D组以Ⅱ期为主(43.6%)。根治性手术切除率和总住院日各组之间的比较,差异有显著性意义(P<0.05和P<0.001),而术后住院日、术后并发症发生率和1、3、5年生存率比较差异无显著性意义(P>0.05)。结论青年人胃癌以女性和低分化腺癌所占比例较高;临床分期较晚;根治性手术切除率较低。老年胃癌患者的总住院时间较长,但老年不是手术的禁忌证。

Objective To investigate the different clinicopathological characteristics and prognosis of gastric cancer patients among different age groups. Methods Clinical data and follow up results of 658 cases with gastric cancer treated in our department from June 1994 to March 2004 were collected. The patients were divided into four different age groups, and clinicopathological characteristics and prognosis were compared among them. Results There were 454 male and 204 female cases with male to female ratio of 2.2∶1. The ages ranged from 19 to 89 years with a mean age of 57.0 years. There were 71 cases in the group of age younger than 40 years(group A), 281 in the group of age within 41 to 60 years(group B), 205 within 60 to 70 years(group C)and 101 cases in the group of age older than 70 years(group D). The total radical resection rate was 82.8%and follow up rate was 95.7%. The median survival time was 30.3 months, and the 1,3,5 year survival rates were 55.3%, 40.2%and 33.2%respectively. In the group A, the male to female ratio was 1∶1.09(34/37). The proportion of female cases was higher than those in the other age groups(P< 0.001). The proportion of poorly differentiated cases was 90.1%(64/71), higher than those in the other groups(P< 0.001). The proportion of distal gastric cancer was highest in each group (35.9%～47.5%). As for clinical stage,most patients(74.6%) were in advanced stage Ⅲand Ⅳin group A. In group B and C,the proportion of patients in stage Ⅲwas 47.5%and 45.4%respectively. In group D,43.6%patients were in stage Ⅱ. There were significant difference in radical resection rate(P< 0.05)and total hospital day(P< 0.001)among these groups. There was no significant difference in postoperative hospital stay, postoperative morbidity, and 1,3,5 year survival rates. Conclusions In young patients with gastric cancer, the proportions of female cases and poorly differentiated adenocarcinoma are higher, the clinical stage is later, and the radical resection rate is lower. Elder patients have a longer total hospital stay,but agedness is not a contraindication for operation.