126例青年胃癌临床特点及预后分析

Clinical features and prognosis of 126 young gastric cancer patients

目的探讨40岁以下青年胃癌患者的临床特点及其预后影响因素。方法纳入126例发病年龄在40岁以下的青年胃癌患者为研究对象,分别采用Log-Rank检验和Cox回归模型进行预后影响因素分析。结果入组胃癌患者的平均年龄33.6岁,女性多于男性(女∶男=1.25∶1),临床表现以上腹疼痛及饱胀不适最为常见,好发部位为胃窦角(43.7%)和胃体(42.9%)。Lauren分型以弥漫型为主(89.7%),中村分型以未分化型为主(91.3%),WHO分型以低黏附性癌最为常见(46.8%),71.4%的患者确诊时已处于肿瘤进展期,最常见的转移部位是腹膜。患者的1年生存率和3年生存率分别为67.3%和46.7%。单因素分析提示血清CA199升高、肿瘤大小、肿瘤浸润深度、区域淋巴结转移、脉管浸润、手术性质均可能影响患者预后。多因素分析提示血清CA199升高、原发肿瘤浸润深度及手术根治性是影响患者预后的独立危险因素。结论青年胃癌恶性程度高,生物学侵袭性强,大多数患者在肿瘤进展期被确诊,总体预后差。血清CA199升高、原发肿瘤浸润深度及手术根治性是影响青年胃癌患者预后的独立危险因素。

Objective To investigate the clinical features and prognostic factors of gastric cancer patients under the age of 40.Methods The clinical data of 126 young gastric cancer patients under the age of 40 were retrospectively analyzed.Log-Rank test and Cox regression model were used to analyze prognostic risk factors,respectively.Results The average age of gastric cancer patients in our group was 33.6 years,and there were more female patients than male patients(female∶male=1.25∶1),Upper abdominal pain and fullness discomfort were the most common clinical manifestations,and the predominant sites were gastric antrum angle(43.7%)and gastric body(42.9%).Lauren type was mainly diffuse type(89.7%),Nakamura type was mainly undifferentiated type(91.3%),and WHO type was the most common type of low-adherence carcinoma(46.8%).71.4%of patients were diagnosed with advanced tumor.The most common site of metastasis was the peritoneum.The 1-year and 3-year survival rates were 67.3%and 46.7%,respectively.The results of univariate analysis showed that the levels of serum CA199,tumor length,depth of tumor invasion,lymphatic metastasis,vascular invasion,and surgical approach were risk factors affecting the prognosis of patients.Multivariate analysis revealed that the levels of serum CA199,the depth of tumor invasion and surgical approach were independent prognostic factors.Conclusion Young gastric cancer has a high degree of malignancy and strong biological invasiveness.Most patients are diagnosed at the advanced stage of the tumor,and the overall prognosis is poor.The levels of serum CA199,the depth of tumor invasion and surgical approach were independent prognostic factors.