老年胃癌患者的临床特点分析

Clinical characteristics of gastric cancer in elderly patients

目的探讨老年胃癌患者的临床特点、诊治方法和预后特点。方法2008年1月至2012年12月间本院收治的245例胃癌患者的临床资料进行回顾性分析。结果腹痛、腹胀是胃癌最常见的临床表现，老年组的发生率高于非老年组（91．6％比76．5％，P〈0．05）；老年组胃癌肿块主要位于贲门和胃底部，占47．9％，非老年组胃窦癌最常见，占54．4％，老年组中有3．1％的患者胃癌为多起源的，而非老年组都是单中心起源。老年组术前合并的慢性疾病多于非老年组，80．o％的胃癌患者接受了手术治疗，根治性切除率为71．3％，老年组与非老年组的比例相近；98．7％的胃癌患者接受化疗，尽管老年组接受三线及其以上化疗的比例（3．5％）比非老年组（9．8％）低（x2=3．197，P=0．081），但差异无统计学意义。在化疗方案选择方面，老年组患者更多选择FOLFOX／XELOX两药联合化疗方案（75．4％）。老年组患者的中位生存时间（27．8个月）较非老年组患者（28．7个月）短，但差异无统计学意义（p=0．813）。结论老年胃癌患者首发症状常以上腹部饱胀、疼痛为主，贲门胃底癌多见，多中心起源，术前并发疾病和术后并发症较多；老年胃癌患者多数可耐受规范的手术和化疗。

Objective To investigate the clinical characteristics of diagnosis, treatment and prognosis of gastric cancer in elderly patients. Methods A total of 245 patients with gastric cancer in our hospital were retrospectively analyzed. Results Abdominal satiety and pain were the most common symptoms, which were higher in elderly group than in non-elderly group （91.6% vs. 76.5%, P〈0.05）. Tumors mostly located in cardia and fundus of the stomach in elderly group （47.9%） and in antrum in non-elderly group （54.4%）. 3.1% of elderly patients had multi-original tumors, while tumors in non-elderly patients were from single-original tumor. The incidences of comorbid chronic diseases were higher in elderly group than in non-elderly group. The surgery and radical operation （RO） resection rates were 80.0% and 71.3%, which were similar in both groups. 98.7% of gastric cancer patients received chemotherapy. Although the proportion of patients who received three lines or more chemotherapy was lower in elderly group than in non-elderly patients, which did not reach a statistical difference （3.5% vs. 9.8%, ）x2 =3. 197, P〈0.05）. Most elderly patients chose FOLFOX/XELOX chemotherapy regimen （75.4%） as compared with non-elderly patients. There was no significant difference in the median survival time between the elderly patients and the non-elderly patients （27.8 months vs. 28.7 months, P〈0.05）. Conclusions Most elderly patients with gastric cancer may present with abdominal satiety and pain at first. Tumors mostly locate in cardiac and fundus of the stomach and multi-original tumors are more common in elderly patients. Preoperative and postoperative complications are higher in elderly patients. Most elderly patients can receive surgery and chemotheraDv. The surerv rate is similar in elderlv and non-elderlv ronns.