慢性胃溃疡早期癌变的临床病理特征及预后

Ciinicopathological features and prognosis of chronic gastric ulcer with early canceration

目的探讨慢性胃溃疡早期癌变的临床病理特征和预后，为其诊断和治疗策略的合理制定提供参考。方法回顾性分析2003年1月至2010年6月间复旦大学附属中山医院收治的43例慢性胃溃疡早期癌变患者的临床及随访资料，比较其与同期343例胃原发型黏膜内癌（其中I～Ⅱ型275例，Ⅲ型68例）临床病理特点及预后的差异。结果43例慢性胃溃疡早期癌变男性30例（69．8％），60岁以下者23例（53．5％）；溃疡位于胃体和胃窦者39例（90．7％），直径小于2cm者26例（60．5％）；癌变后23例为未分化型（53．5％），4例（9．3％）出现淋巴结转移。43例慢性胃溃疡早期癌变患者中有4例病灶位于胃上1／3，而Ⅲ型黏膜内癌均位于胃中下2／3，差异有统计学意义（P〈O．01）。而在细胞分化程度、脉管癌栓和淋巴结转移等其他临床病理特征方面，溃疡早期癌变与原发型Ⅲ型以及I一Ⅱ黏膜内癌的差异均无统计学意义（均P〉O．05）。43例慢性胃溃疡早期癌变患者术后中位随访57（16—98）月，5年总生存率为95．3％，与I～Ⅱ型（97．4％）和Ⅲ型（94．5％）黏膜内癌比较，差异无统计学意义（P=O．632）。结论慢性胃溃疡早期癌变的临床病理特征与原发型胃黏膜内癌相似，预后良好，经根治性手术治疗能够取得满意疗效。

Objective To evaluate the clinicopathological features and prognosis of chronic gastric ulcer with early canceration in order to provide useful information for diagnosis and treatment strategies. Methods A retrospective review of clinical data and prognosis from 43 patients of chronic gastric ulcer with early canceration from 2003 to 2010 was conducted. These data were compared with those with primary intra-mucosa gastric cancer （type I and 1I 275 cases, type Ⅲ 68 cases）. Results In 43 cases of chronic gastric ulcer with early canceration, 30 cases （69.8%） were male, 22 cases （51.2%） were younger than 60 years old. Lesions located in the body or antrum of the stomach in 39 cases（90.7%）, were less than 2 cm in 26 cases（60.5%）, were undifferentiated type in 23 cases（53.5%）, and developed lymph node metastasis in 4 cases（9.3%）. Lesions of 4 cases of chronic gastric ulcer with early canceration located in the upper third of the stomach, while those of type Ⅲ primary intra-mucosal gastric cancer all located in the lower two thirds, and the difference was statistically significant （P〈0.01）. Compared to typeⅢ and type I and 11 primary intra-mucosal gastric cancer, chronic gastric ulcer with early canceration did not differ in clinicopathological characteristics such as histological type, vascular or lymphatic invasion, and lymph nodes metastasis（all P〉0.05）. The median follow-up time was 57 months （range 16 to 98 months）. The 5-year overall survival was 95.3%in chronic gastric ulcer with early canceration group, similar to that of type I , Ⅱ （97.4%） or type Ⅲ （94.5%） primary intra-mucosal gastric cancer group （P〉0.05）. Conehtsions The clinicopathological features of chronic gastric ulcer with early canceration are similar to those of primary intra-mucosal gastric cancer. The prognosis is promising for those patients undergoing surgical treatment.