青年与老年胃癌178例病理生物学行为比较分析

Comparative study of gastric cancer pathobiological behavior in young and elderly patients

目的对青年与老年胃癌病例的病理生物学行为进行比较,根据其不同生物学特点指导临床治疗。方法对96例青年胃癌(<35岁)和82例老年胃癌(>75岁)的病理生物学资料进行比较分析。结果青年组男女比例为1∶1,老年组男女比例为3.6∶1;青年组有肿瘤家族史者20例,而老年组仅为7例;青年与老年组肿瘤部位均以L部居多,老年组中上部癌明显增多占15.9%;Borrmann分型均以3型居多,但两组3型所占比例差异有统计学意义;青年组与老年组相比浸润能力强、分化差、生长方式不良,两组之间差异均有统计学意义;TNM分期青年组Ⅲb、Ⅳ期居多占43.3%,老年组Ⅱ、Ⅲa期居多占57.3%;青年组腹膜转移27例,老年组8例,肝转移分别为10例及2例。结论青年胃癌恶性度相对较高,提高胃癌的早期诊断率是提高其5年生存率的关键,应尽量施行根治性手术,必要时行扩大根治术;而老年病例恶性度较低,可适当缩小手术,对于Ⅱ、Ⅲ期病例只要全身状态允许亦应行标准根治性手术治疗。

Objective To study the difference of gastric cancer pathobiological behaviors in young and elderly patients. Methods In 96 young patients （ 〈 35 years） and 82 elderly patients （ 〉 75 years） with gastric cancer, the pathobiological behaviors were compared according to tumor location, general type, histological type, depth of invasion, TNM staging, growth type and metastasis. Results In young and elderly group, the male to female ratio was 1 ： 1 and 3.6 ： 1 respectively. Twenty young patients and 7 elderly patients had family history respectively. Most tumors grew at L part of stomach in both groups,but the tumors at U part were increased in elderly group. General types in young group were as follows ： Borrmann 3 〉 Borrmann 4 〉 Borrmann 2 〉 Borrmann I, and those in elderly group Borrmann 3 〉 Borrmann 2 〉 Borrmann 4 〉 Borrmann 1. As compared with elderly patients, young patients had stronger invasion ability,worse differentiation and worse growth type. The ratio of TNM staging （ Ⅲb,Ⅳ stage） in young group was 43.3 % ,while that in elderly group （ Ⅱ,Ⅲ a stage） was 57.3 %. Peritoneal metastasis occurred in 27 young patients and 8 elderly patients and hepatic metastasis in 10 young patients and 2 elderly patients respectively. Conclusion Young patients with gastric cancer have a poor pathobiological behavior. Increasing the early diagnosis rate is the key to increase 5 - year survival rate. Radical operation should be done,and extended radical correction when necessary. Elderly patients with gastric cancer had a batter pathobiological behavior. For those with Ⅱ,Ⅲ stages D2 operation should be done if the body conditions are all right.