70岁以上老年胃癌患者临床特点及预后

Clinical features and prognosis of gastric cancer in patients over 70 years old

目的探讨70岁以上高龄胃癌患者的临床表现、诊治方法和预后特点。方法回顾性分析我院1997年～2010年间128例胃癌患者临床资料,比较两组患者(≥70岁,高龄组;<70岁,低龄组)的临床特点和预后。结果高龄组48例,占37.5%,与低龄组患者相比,其男性发病率(93.7%vs 76.2%)、心脏病发生率(70.8%vs 27.5%)、脑血管病发生率(20.8%vs 6.3%)、二重癌发生率(6.3%vs 1.3%)及无症状发病率(20.8%vs 11.2%)显著增高(P<0.001～0.035),但吸烟率(18.7%vs 37.5%)较低(P=0.025)。高龄组贲门胃底癌多见,占27.1%,中-高分化癌占31.2%,而低龄组胃窦癌占42.5%,多为低分化-未分化癌(80.0%);发病时两组TNM分期未见显著差异,但长期随访高龄组肿瘤远处转移发生率显著低于低龄组(8.3%vs 35.0%,P=0.0048)。两组共75.0%的患者接受手术治疗,两组根治性切除率相似(60.4%vs 61.25%,P=0.21);而接受化疗的高龄组患者显著低于低龄组(56.2%vs 85.0%,P<0.001),其中因不良反应终止化疗高龄组患者占10.4%,略高于低龄组(6.2%),但差异无统计学意义。高龄组患者中位生存时间(27.8个月)较低龄组患者(19.3个月)有延长趋势,但差异无统计学意义(P=0.062)。结论 70岁以上胃癌患者男性多见,多无症状起病或缺乏典型症状,贲门胃底癌多见,中-高分化癌比例超过70岁以下患者,较少发生远处转移。虽高龄患者有较高的心脑血管疾病合并率,但多数可耐受规范的根治性手术和术后化疗。积极治疗可有效延长老年患者的平均生存时间。

Objective To investigate the clinical characteristics,diagnosis,treatments and prognosis of gastric cancer in patients over 70 years old.Methods A total of 128 patients with gastric cancer from a tertiary hospital were indentified.The clinical data and follow-up information of these patients were reviewed and retrieved,and the related clinical features of patients at an advanced age more than 70 were compared with those who were younger than 70 years.Results Compared with the younger patients,the clinical data of more elderly patients including the proportion of male（93.7% vs 76.2%）,percentage of comorbid cardiovascular（70.8% vs 27.5%）,cerebrovascular disease（20.8% vs 6.3%）,incidence of duplicate cancer（6.3% vs 1.3%） and asymptomatic patients（20.8% vs 11.2%） were significantly higher.However,the percentage of cigarette-smoking in patients of elderly age was lower than that in younger patients（18.7% vs 37.5%,P=0.025）.The pathological results indicated that the lesions in elderly patients were more common in cardia and gastric founder（27.1%）,and 31.2% of gastric cancer were moderately to highly differentiated.Lesions in gastric antrum were more frequently seen（42.5%） in younger group with a severe disease of poor and undifferentiated tumor（80.0%）.No difference was found in TNM stage at first diagnosis between two groups.However,incidence of distant metastasis during follow-up was lower in elderly group than that in younger group（8.3% vs 35.0%,P=0.0048）.The overall rate of surgical operation was 75.0%,with a similar resection rate in two groups.Only 56.2% of elderly patients received chemotherapy,which was lower than that of younger patients（85.0%,P0.001）.The median survival time was similar in two groups（27.8 months for patients of elderly age,19.3 months for younger,P=0.062）.Conclusion Male patients with gastric cancer were more prevalent in elderly peoples.The patients over 70 years old were prone to be asymptomatic or absent of typical symptoms,and the lesions were more frequently seen in cardia and gastric founder.The rate of moderately and highly differentiated tumor was higher in elderly patients,with a lower probability of distant metastasis.Although a higher incidence of comorbid cardio-cerebrovascular disease in patients over 70 years old,the curative operation,chemotherapy and combined treatment option might be relatively safe and could benefit to these elderly patients with an improved survival time.