不同部位胃癌组织临床病理特点和生物学行为的差异

Comparative analysis of clinicopathologic features and lymph node metastasis between patients with upper and lower gastric carcinoma

目的:探讨胃上部癌与胃下部癌临床病理特点和生物学行为差异.方法:回顾性分析我院收治的107例胃上部癌和505例胃下部癌患者临床病理相关因素,并对癌淋巴转移与病理因素的关系进行分析.结果:胃上部癌与下部癌患者在性别(86.92%v s 69.31%)、(13.08%v s 31.09%),年龄(3.74%vs 10.50%)、(14.02%vs 20.00%)、(36.45%vs 29.31%),病灶大小(43.93%vs51.88%)、(5.61%vs 2.18%),大体类型(2.80%vs 8.71%)、(29.91%vs 35.84%)、(67.29%vs 55.45%),组织分型(48.60%vs 56.44%)、(51.40%vs 43.56%),生长方式(20.56%vs35.05%)、(46.73%v s 32.28%),病理分期(6.54%vs 23.37%)、(12.15%vs 32.48%)、(51.40%vs 27.13%)、(29.91%vs 17.03%),浸润深度(2.80%vs 8.71%)、(32.71%vs29.11%)、(13.08%vs 6.34%)分布以及器官受侵(27.10%vs 28.51%),浆膜受侵(63.55%vs 34.65%),断端残留(9.35%vs 0.99%)发生率上存在显著差异,差异具有统计学意义(P<0.05);胃上部癌、胃下部癌患者肿瘤大体类型(33.33%vs 40.63%vs 59.72%)、(9.09%vs 44.20%vs 62.86%)、生长方式(13.64%vs 57.14%vs 68.00%)、(24.86%vs35.15%vs 74.85%)、浸润深度(33.33%vs38.18%vs 60.00%vs 100.00%)、(9.09%vs43.62%vs 70.07%vs 96.88%)以及是否发生浆膜入侵(30.77%vs 66.18%)、(40.91%vs72.00%)均为影响淋巴结转移的主要因素,差异具有统计学意义(P<0.05);胃上部癌、胃下部癌患者肿瘤病灶大小(40.43%vs 61.11%vs 83.33%)、(42.75%vs 60.78%vs 72.73%),组织分型(53.85%vs 52.73%)、(54.39%vs48.18%)均与淋巴结转移无关,差异无统计学意义(P>0.05);胃上部癌患者淋巴结总转移率与胃下部癌患者比较(53.27%vs 51.68%),差异无统计学意义(P>0.05),表明肿瘤发生部位与淋巴结转移率无关.结论:胃上部癌与胃下部癌临床病理生物学行为和淋巴结转移规律存在多方面差异,与胃下部癌相比,胃上部癌具有病灶较大、呈浸润型弥漫生长、分化程度低、浆膜易受侵、病期偏晚等特点,而淋巴转移方面并不突出,这可能是导致胃上部癌预后较差的重要原因.

AIM： To compare the clinicopathologic features and lymph node metastasis between patients with upper and lower gastric carcinoma.METHODS： One hundred and seven patients with upper gastric carcinoma and 505 patients with lower gastric carcinoma were analyzed. The clinicopathologic features and the relationship between lymph node metastasis and clinicopathologic features were analyzed.RESULTS： There were significant difference between patients with upper gastric carcinoma and those with lower gastric carcinoma（P〈0.05） in sex, age, tumor size, subtype, histologic type, growth pattern, stage, depth of invasion, organ invasion, serosal involvement and margin residue. The main factors significantly differently affecting lymph node metastasis between patients with upper gastric carcinoma and those with lower gastric carcinoma were subtype,growth pattern, depth of invasion, and serosal involvement（P〈0.05）, while tumor size and histological type showed no significant impact.There was no significant difference in the rate of lymph node metastasis between patients with upper and lower gastric carcinoma（53.27% vs51.68%）, indicating that there was no relationship between tumor location and rate of lymph node metastasis.CONCLUSION： There are significant differences in clinicopathological parameters and lymph node metastasis between patients with upper and lower gastric carcinoma. Compared with patients with lower gastric carcinoma, those with upper gastric carcinoma often have larger tumors, infiltrating growth, poor differentiation,serosal invasion and advanced stage. This is the possible reason for poor prognosis of upper gastric carcinoma.