90例青年胃癌患者的临床病理特征及预后分析

Clinicopathologic characteristics and prognosis analysis of 90 young patients with gastric cancer

目的研究发病年龄≤40岁的青年胃癌患者的临床病理特征及预后。方法回顾性分析2013年1月至2014年12月复旦大学附属中山医院普通外科收治的90例发病年龄40岁以下的青年胃癌患者的临床病理资料。通过术后随访了解患者生存情况，随访截止时间为2016年10月。分别采用Log-rank检验和Cox回归模型进行预后危险因素分析，纳入分析的因素包括患者性别、年龄、肿瘤大小、肿瘤分化程度、组织学类型、Lauren分型、T分期、N分期、脉管癌栓、临床症状、有无贫血、CA199水平等。结果90例青年胃癌患者中位年龄为35岁，其中年龄≤30岁者20例（22.2%），31-40岁70例（77.8%）。女性70例（77.8%），术前贫血38例（42.2%），术前CA199阳性11例（12.8%），存在消化道肿瘤家族史者9例（10.0%）。所有患者出现症状至就诊的平均时间为8.2月。术后病理：低分化腺癌65例（72.2%），黏液腺癌6例（6.7%），印戒细胞癌9例（10%），乳头状管状腺癌10例（11.1%）；进展期患者69例（76.7%），淋巴结转移67例（74.4%）。单因素分析结果显示，性别（P = 0.021）、肿瘤大小（P = 0.001）、肿瘤浸润深度（P = 0.016）、淋巴结转移（P = 0.000）、脉管癌栓（P = 0.001）、CA199升高（P = 0.001）及术前贫血（P = 0.024）与术后生存时间有关。多因素分析证实，淋巴结转移是影响本组青年胃癌患者预后的独立危险因素（HR = 2.774，95%CI：1.435-5.364，P = 0.002）。结论青年胃癌以女性患者为主，病理多为低分化腺癌，就诊时多为进展期且已有淋巴结转移；其预后不良的独立危险因素是淋巴结转移。

Objective To investigate the features of clinicopathology and prognosis in young gastric cancer patients. Methods Clinicopathological data of 90 young gastric cancer patients （-〈40 years old） who received radical gastrectomy in the Department of General Surgery of Zhongshan Hospital, Fudan University from January 2013 to December 2014 were retrospectively analyzed. Survival data were obtained by follow-up and the last follow-up time was October 2016. Log-rank test and Cox regression model were used to analyze the risk factors of prognosis and these factors included gender, age, tumor size, degree of differentiation, histological type, Lauren pattern, T stage, N stage, vessel carcinoma embolus, clinical symptom, anemic condition, CA19-9 level, et al. Results The median age of 90 patients was 35 years old, of whom, 20 （22.2%） patients were -〈 30 years old and 70 （77.8%） patients were between 31 and 40 years old. There were 70 （77.8%） female patients, 38 （42.2%） patients with anemia, 11 （12.8%） patients with elevated CA19-9 level and 9 （10.0%） patients with family history of gastrointestinal tumors. The mean time of all the patients from presence of symptom to consultation was 8.2 months. Postoperative pathology revealed 65 （72.2%） patients with poorly differentiated adenocarcinoma, 6 （6.7%） patients with mucinous adenocarcinoma, 9 （10%）patients with signet-ring cell carcinoma, and 10 （11.1% ） patients with papillary-canalicular adencarcinoma. Sixty-nine （76.7%） patients were diagnosed as advanced gastric cancer and 67 （74.4%） patients were involved with lymphatic metastasis when they visited our hospital. Univariate analysis showed that gender （P=0.021）, tumor size （P=0.001）, depth of tumor infiltration （P=0.016）, lymphatic metastasis （P=0.000）, vessel carcinoma embolus （P= 0.001）, elevated CA19-9 level （P---0.001）, and anemia （0.024） were statistically related with postoperative survival. Multivariate analysis showed that lymphatic metastasis was an independent risk factor of the poor prognosis of young patients （HR： 2.774, 95%CI： 1.435 to 5.364, P= 0.002）. Conclusions The majority of young gastric cancer cases are female with poorly differentiated adenocarcinoma. Most patients are diagnosed as advanced gastric cancer with lymphatic metastasis when they visit hospital at the first time. The lymphatic metastasis is an independent risk factor of prognosis in young gastric cancer patients.