40岁以下青年人胃癌的淋巴结转移特点

The lymph-node metastasis characteristics of patients younger than 40 years with gastric carcinoma

目的探讨40岁以下青年人胃癌的淋巴结转移特点,及其与病人预后的关系。方法回顾性分析1988年1月至2008年12月间收治的有完整病理学分期资料的胃癌159例,按年龄分为≤40岁组(31例)和40岁以上组(128例),比较两组淋巴结转移情况。结果≤40岁组有淋巴结转移者26例(83.9%);40岁以上组有淋巴结转移者80例(62.5%),经统计学分析两组病人之间淋巴结转移数目、淋巴结转移率及N2、N3站淋巴结的转移率,差异均有统计学意义。≤40岁组总体的中位生存时间为27个月,40岁以上组为33个月,两组比较差异有统计学意义(P<0.05)。行根治术的中位生存时间≤40岁组为34个月,40岁以上组为36个月,两组比较差异无统计学意义(P>0.05)。结论 40岁以下青年胃癌病人的淋巴结转移数目多,转移率高,病理学分期晚,预后差;提高诊断率,进行标准化的胃癌根治术是提高青年胃癌病人生存率的关键。

Objective To discuss the lymph-node metastasis features of patients younger than 40 years with gastric carcinoma and try to explain the relationship between their prognosis and age. Methods We reviewed the pathologic data of 159 patients with gastric carcinoma from January 1988 to December 2008. The patients were divided into the young（age≤40 years） group（n = 31 ） and the old （age〉40 years） group （n = 128）. The pathological characteristics were compared between the two groups. Results Twenty-six patients（83.9 %） had lymph-node metastasis in young patient group,and 80 patients（62.5 %） had lymph-node metastasis in old group. There was significant difference in the number of lymph-node metastasis, the ratio of lymph-node metastasis and the lymph-node metastasis rate in N2, N3 stage between ≤40 years group and 〉40 years group. The median survival time of young and elderly patients was 27 months and 33 months respectively（P〈0. 05）. The median survival time of young and elderly patients after radical resection was 34 months and 36 months respectively with the difference being not significant（P〉0. 05）. Conclusion The pathological characteristics of young patients with gastric carcinoma were identified： the more number of lymph-node metastasis and the higher ratio of lymph-node metastasis were strongly correlated with poor prognosis. Earlier diagnosis and standard D2,D3 lymph-node dissection are keys to improve the prognosis.