青年胃癌的临床特征

Clinical Characteristics of Gastric Cancer in Young Patients:A Retrospective Cohort Study

目的探讨青年胃癌患者的临床特征,分析影响其预后的因素。方法回顾性分析上海交通大学医学院附属第九人民医院和复旦大学附属华山医院静安分院2005年1月~2015年12月收治的535例胃癌患者的临床资料,比较分析青年胃癌患者和中老年胃癌患者的临床特征及病理分型特点,探讨可能影响青年患者胃癌的预后因素。结果青年组中男女比例高于中老年组,最突出的临床表现为上腹痛,中老年组以消瘦、上消化道出血及上腹部疼痛及不适为主,二者差异有统计学意义(P<0.0001);在病变部位方面,青年组多以胃窦为主,同时全胃比例高,而中老年患者胃中上1/3占比高于青年组。H.pylori感染方面:青年组感染率(70.37%,57/81)明显高于中老年组(29.96%,136/454)(P<0.0001);中老年组较青年组有更高的消化性溃疡史(P<0.0001);青年组的Lauren分型弥漫型胃癌的比例高于中老年组。青年组5 a总体生存率低于中老年组(P=0.008)。结论青年组中女性比率高,分布以胃窦为主,有更高的H.pylori感染率、组织分型以弥漫型和混合型为多,5 a总体生存率青年组低于中老年组。

Objective The rate of gastric cancer in young patients has increased over the past few decades.The aim of this study was to analyze the clinical characteristics of young patients with gastric cancer,and investigate the possible risk factors that may be related to the survival rate of young patients.Methods From January 2005 to December 2015 a series of 535 consecutive patients were admitted to our hospitals because of a gastric cancer.We carried out a retrospective cohort study in 81 patients younger than 40 years old and in 454 patients aged 40 years older.The comparison was involved in the evaluation of patient and tumor characteristics.Results The proportion of the female in the young group was higher than that in the middle-aged and old group.The young patients had significantly more preoperative abdominal pain,while the elder had more weight loss as well as upper gastrointestinal bleeding and abdominal pain.There was no significance in duration of symptoms before the diagnosis between the two groups;In terms of lesion,pathological change occurred at the antrum or full stomach was seen more often in young patients,while elderly patients often had lesions at the upper part of corpus or the fundus.Helicobacter pylori infection and diffuse histological type were significantly associated with younger age.There was also statistically significant difference regarding overall and cancer-related 5-year survival;advanced cancer stage and diffuse histological type were the independent negative prognostic factors influencing cancer-related survival.Conclusion In our study,the proportion of the female in young patiants was higher than that in the middle-aged and old patiants and had more Helicobacter pylori infection,as well as the diffuse histological type of gastric cancer along with poor cancer-related 5-year survival rate,but we do not have sufficient evidence to consider gastric cancer in female patients as a different clinical entity.Further studies are needed to understand carcinogenesis in younger patients,especially females.