Coexistence of gastrointestinal stromal tumor, esophageal and gastric cardia carcinomas

Gastric gastrointestinal stromal tumor (GIST), esophageal squamous cell carcinoma and gastric cardia adenocarcinoma are distinct neoplasms originating from different cell layers; therefore, simultaneous development of such carcinomas is relatively rare. Auxiliary examinations revealed coexistence of esophageal and gastric cardia carcinoma with lymph node metastasis in a 77-year-old man. Intraoperatively, an extraluminal tumor (about 6.0 cm × 5.0 cm × 6.0 cm) at the posterior wall of the gastric body, a tumor (about 2.5 cm × 2.0 cm) in the lower esophagus, and an infiltrative and stenosing tumor (about 1.0 cm × 2.0 cm) in the gastric cardia were detected. Wedge resection for extraluminal gastric tumor, radical esophagectomy for lower esophageal tumor, and cardiac resection with gastroesophageal (supra-aortic arch anastomoses) were performed. Postoperative histological examination showed synchronous occurrence of gastric GIST, esophageal squamous cell carcinoma, and gastric cardia adenocarcinoma. Furthermore, immunohistochemistry indicated strong staining for c-Kit/CD117, Dog-1, Ki-67 and smooth muscle, while expression of S-100 and CD34 was negative.

Adenocarcinoma of gastric cardia in the elderly: Surgical problems and prognostic factors

AIM： To analyze retrospectively, our results about patients who underwent surgical treatment for adenocarcinoma of the cardia in relation to age, in order to evaluate surgical problems and prognostic factors. METHODS： From January 1987 to March 2003, 140 patients with adenocarcinoma of the cardia underwent resection in the authors＇ institution. They were divided into three groups with regard to age. Patients 〈70 and 〉 60 year old （31） were excluded; we also excluded 18 out of 109 patients with poor general status or systemic metastases. So, we compared 51 elderly （≥ 70 year old） and 58 younger patients （≤ 60 year old）. The treatment was esophagectomy for type I tumors, and extended gastrectomy and distal esophagectomy for type Ⅱ and Ⅲ lesions. RESULTS： Laparotomy was carried out in 91 patients （83.4%）, 38 in the elderly （74.5%） and 53 in younger patients （91.3%, P〈0.05）. Primary resection was performed in 81 cases （89%） without significant differences between the two groups. Postoperative death was higher in the elderly （12.1%） than the other group （4.1%, P〈0.05）, while morbidity was similar in both groups. A curative resection （R0） was performed in 59 patients （72.8%）, 69.6% in the elderly and 75% in the younger group （P〉0.05）. The overall 3- and 5-year survival rates were 26.7% and 17.8% respectively for the elderly and 40.7% and 35.1% respectively for younger patients （P = 0.1544）. Survival rates were significantly associated with R0 resection, pathological node-poskive category and tumor differentiation in both groups.CONCLUSION： As the age of the general population increases, more elderly patients with gastric cardia cancer will be candidates for surgical resection. Age alone should not preclude surgical treatment in elderly patients with gastric cardia cancer and a tumor resection can be carried out safely. Certainly, we should take care in defining the surgical treatment in elderly patients, particularly as regarding the surgical approach; although the surgical approach does not influence the survival rate, the transhiatal way still remains the best one due, to the lower incidence of respiratory morbidity and thoracic pain.

Study of the Value of Combined Multiorgan Resection in Surgical Treatment of Carcinoma of the Gastric Cardia

OBJECTIVE： To determine the value of resection of combined visceral organs in surgical treatment of gastric cardiac carcinoma. METHODS： We retrospectively analyzed 217 random patients with carcinoma of the gastric cardia who underwent a gastric cardiac resection. The patients had been treated as follows： 186 with partial gastrectomy, 31 with total gastrectomy, 97 with a combined-visceral resection, of which 82 underwent a splenectomy plus partial pancreatectomy, 10 with splenectomy alone and 5 with partial hepatectomy and diaphragmatectomy. RESULTS： The total patients were divided into 3 groups： 128 with a gastrectomy alone, 10 with gastrectomy and splenectomy, and 82 with gastrectomy and splenectomy plus pancreatectomy. The operating times for these 3 groups were respectively 3.0 h, 3.1 h and 3.8 h. The hospitalization times were respectively 23.8 d, 31.2 d and 25.9 d. No differences in post-operative complications were found between these 3 groups. There were 92 patients who underwent a gastrectomy combined with a splenectomy and （or） the pancreatectomy, in which 92 No.10 lymph nodes were eliminated, with an average of one in each patient. Among the 125 patients not receiving a splenectomy but with elimination of lymph nodes, 82 underwent a gastrectomy combined with partial pancreatectomy, of which 107 lymph nodes were eliminated for the No. 11 group, with an average of 1.3 in each patient. There was a statistically significant difference between the 2 groups. The overall survival rates were similar in the 3 groups showing no statistical differences, but was higher in the Stage Ⅲ patients with a combined resection of multi-organs. For patients in the Stage Ⅳ without resection of multi-organs, the survival rate was higher, but there was no significant difference between the 2 groups. CONCLUSION： It is difficult to determine precisely the involvement of para-tumorous organs with the eye during an operation. Combining a splenectomy with a pancreatectomy does not increase the post-operative complications following surgical treatment for carcinoma of the gastric cardia. The combination of a splenectomy and partial pancreatectomy results in a higher survival rate and has an important significance for eliminating the lymph nodes of group 10 and 11, especially for patients in Stage Ⅲ. In the application of a resection combining multi-organs, the doctor should make every effort to decrease the trauma and the complications based on the condition that the cancerous tissue is totally resected.

Human papillomavirus DNA and P16～(INK4A) expression in concurrent esophageal and gastric cardia cancers

AIM:To investigate the relationship between human papillomavirus (HPV) infection and concurrent esophagus and gastric cardia cancer from the same patient (CC) and examine the significance of P16 INK4A protein expression.METHODS:Polymerase chain reaction was used to detect the presence of HPV type16 (HPV16).The expression of P16 INK4A protein was detected using immunohistochemistry.RESULTS:Among the CC specimens,HPV16-DNA was found in eight cases of esophageal squamous cell carcinoma (ESCC) and five cases of gastric cardia adenocarcinoma (GCA),respectively (47% vs 29%),and two of both ESCC and GCA.P16 INK4A was highly expressed in both ESCC and GCA.In the HPV-associated positive CC,higher P16 INK4A expression was observed in the GCA than in the ESCC (75% vs 25%,P < 0.05).CONCLUSION:HPV16 as a correlated risk factor may play an important role in the development of ESCC and GCA.P16 INK4A may be a screening index in the HPVassociated carcinoma of gastric cardia.

Despite shared susceptibility loci, esophageal squamous cell carcinoma embraces more familial cancer than gastric cardia adenocarcinoma in the Taihang Mountains high-risk region of northern central China

Background In China, esophageal squamous cell carcinoma （ESCC） and gastric cardia adenocarcinoma （GCA） share susceptibility loci, but different rates of multiple primary cancer and male/female ratio suggest the proportion of familial cancer is not equal. Methods The percent of cases with a positive family history, median onset age, rate of multiple primary cancer, and male/female ratio associated with upper, middle, lower third ESCC and GCA were compared to reveal the proportion of familial cancer. The 7267 subjects analyzed constituted all ESCC and GCA cases in whom the cancer was resected with cure intention between 1970 and 1994 at the 4th Hospital of Hebei Medical University. Results A positive family history for cancer was most often associated with the multiple primary ESCC and/or GCA cases, e.g. with 42% of the males and 59% of the females. For upper, middle, lower third ESCC and GCA, the percent of cases with a positive family history decreased by 38.5%, 26.3%, 26.5%, and 11.2% in males （P 〈0.000） and 25.0%, 22.3%, 23.9%, and 9.8% in females （P 〈0.0001）. Median onset age increased from 49, 52, 55, to 56 years old in males and from 50, 53, 55, to 56 years old in females （ both P 〈0.0001） for upper, middle, lower third ESCC and GCA. Male/female ratio increased from 2.2, 2.1, 2.2, to 6.2：1 for upper, middle, lower third ESCC and GCA （P〈0.0001）. For upper, middle, lower third ESCC and GCA, the percent of multiple primary cancers decreased from 21.2%, 2.3%, 2.2%, to 1.5% in males and from 14.3%, 2.4%, 3.4%, to 3.1% in females. The preponderance of males, smoking, drinking, or onset-age 〉50 years was significantly higher in GCA than in ESCC, and the difference in the rates of multiple primary cancers between the preponderant and the non-preponderant cases was significant in GCA, but not in ESCC, suggesting non-equal requirement for genetic susceptibility when environmental hazards did not exist. Conclusions The proportion of familial cancer in upper gastrointestinal carcinomas decreases by the priamry site of upper, middle, lower third esophagus and gastric cardia. Considering familial and sporadic cancers differ in preventability, screening strategy and recurrence, our findings have basic and clinical implications.

SUPERFICIAL CARCINOMAS OF THE ESOPHAGUS AND GASTRIC CARDIA A CLINICOPATHOLOGICAL ANALYSIS OF 141 CASES

From January 1970 to June 1999, 141 patients with superficial esophageal and cardiac carcinomas (SEC and SCC) underwent surgical treatment, Of the 141 patients 128 (90.8%) had slight symptoms related to swallowing, and the remaining 13 (9.2%) were asymptomatic, Balloon cytology and esophagoscopy proved very useful for the diagnosis of SEC and SCC, and Lugol's solution staining technique was an effective auxiliary diagnostic measure, Lymph node metastasis was not found in patients with epithelial (EP) cancer, However, it was present in one (2.9%) of 34 patients with muscularis mucosal (MM) invasion, and in 5 (8.6%) of 58 patients with submucosal (SM) cancer, The 5-year survival rates of the patients with SEC and SCC were 75.5% and 71.4%, respectively (P > 0.05). The different depth of tumor invasion including EP, MM and SM cancers showed significant differences in the 5-year survival rate (P < 0.05), Although the prognosis for the patients with lymph node metastasis is poor, we should advocate extended lymph node dissection in surgical treatment of the patients in whom MM and SM cancers are suspected.

贲门癌手术径路与疗效的关系研究

目的:探讨贲门癌手术径路的选择与外科治疗效果的关系。方法:随机抽取天津市肿瘤医院资料完整的贲门癌手术切除病例217例,回顾性分析其手术径路与疗效之间的关系,判定各径路的优劣。结果:腹部径路创伤小、失血少、手术时间短,易于术后恢复,但较难以切除足够长的食管及行下纵隔的淋巴结清扫。左胸径路可切除足够长的食管,有利于纵隔淋巴结的清扫,但腹腔暴露差,施行全胃切除、联合胰脾切除及5、6、8、9、12、13、14等组淋巴结的清扫有一定的难度。胸腹联合径路腹腔暴露好,便于行全胃切除及脏器联合切除,能切除足够长的食管和施行彻底的下纵隔淋巴结清扫并能进行D2淋巴结清扫,对肿瘤不能切除的患者避免了开胸探查,但是创伤大,可能引起较多的并发症和较高的死亡率。结论:3种手术径路各有其优缺点。手术径路的选择需根据病变部位、病变大小、疾病分期、患者体质以及医生的经验和技术水平等因素综合考虑而决定。单一的手术径路并非是影响预后的独立因素。

双S空肠间置术预防贲门癌切除术后反流性食管炎

目的：探讨消化道重建方式对贲门癌切除术后反流性食管炎的预防作用。方法：自１９９５ 年２ 月～１９９６ 年１０ 月采用双Ｓ空肠间置术行贲门癌切除术后消化道重建，并以传统的食管胃吻合法作对照。将术后无病生存１ 年以上的７４ 例作为本文观察对象。其中双Ｓ组３８ 例，传统组３６ 例。结果：１） 食管胃反流症状发生率：传统组７５％ ，双Ｓ组５．３％ ，两组间有非常显著性差异（ Ｐ＜０．０１） 。２）ｐＨ 值测定：食管下段ｐＨ 平均值传统组４．８ ，双Ｓ组６．９ ，两组间有显著性差异（ Ｐ＜ ０．０５）。３） 上消化道钡餐造影：传统组２３ 例发现钡剂反流入食管，发生率为６３．９％ ，双Ｓ组仅有４例，发生率为１０．５％ ，两组间有非常显著性差异（ Ｐ＜０．０１） 。结论：采用Ｓ空肠间置术行消化道重建对预防贲门癌切除术后反流性食管炎具有良好的临床效果。该手术方法简便，不受残胃大小的限制，间置空肠血运良好，优于目前采用的其它抗反流手术，值得推广应用。

保留幽门全胃切除间置空肠代胃术

报告6例贲门胃底癌及胃体上部癌行根治性全胃切除，保留幽门问置空肠代胃术的临床效果。选择5、6组淋巴结无转移，不影响根治效果的6例病人，行保留幽门全胃切除术后，将25cm空肠间置于食管与十二指肠之间。术后通过临床观察，上消化道锁餐X线摄片、电子纤维胃镜检查及食管、问五空肠活检等证明此术式有良好的抗返流作用，并延长了食物在“代胃”内停留时间，幽门录作用正常。术后3个月、半年、1年钡餐摄片观察代胃扩张，幽门开放功能良好，无返流现象；术后半年、1年、2年电子胃镜检查并活检，无返流性食管炎发生。生存期与同期不保留幽门间置空肠代胃术相比，无显著性差异。

食管癌、贲门癌术后呼吸功能不全高危因素分析

目的:探讨食管癌和贲门癌术后发生呼吸功能不全的高危因素。方法:采用回顾性病例对照研究,应用Logistic回归分析食管癌和贲门癌术后呼吸功能不全发生的高危因素。结果:经Logistic回归分析,术后发生呼吸功能不全的高危因素按相关强度依次为:术前合并COPD、手术时间长、高龄、手术日输液量多。结论:术前合并COPD(chronic obstructive pulmonary disease)、手术时间长、高龄是食管癌术后发生呼吸功能不全的高危因素;严格手术适应证,术者的丰富经验及娴熟技术,积极围手术期处理是防治术后呼吸功能不全的有效措施。

贲门癌癌旁和无症状人群贲门黏膜活检组织肠上皮化生检测

目的:探讨贲门癌癌旁组织及无症状人群贲门黏膜活检组织肠上皮化生(IM)的分布特征。方法:采用艾显蓝-雪夫(AB-PAS)和高铁二胺-艾显兰(HID-AB)黏液组织化学染色法,对河南贲门癌高发区70例贲门癌癌旁组织和320例无症状人群贲门黏膜活检组织中的IM进行检测。结果:贲门癌癌旁组织的IM检出率38.5%(27/70),高于无症状人群贲门黏膜活检组织中的IM检出率4.4%(14/320)(χ2=71.3945,P<0.01)。贲门癌癌旁组织IM不完全型占92.6%(25/27),完全型IM占7.4%(2/27);无症状人群贲门黏膜的IM不完全型占7.1%(1/14),完全型IM占92.9%(13/14);2者比较,差异有统计学意义(χ2=29.0157,P<0.01)。贲门癌旁组织的IM大肠型占59.2%(16/27),小肠型占40.8%(11/27);无症状人群贲门黏膜的IM小肠型占92.9%(13/14),大肠型占7.1%(1/14);2者比较,差异有统计学意义(χ2=10.3173,P<0.01)。结论:IM可能是河南贲门癌高发区贲门癌癌前病变的一种重要表现形式;不完全型和大肠型IM可能是贲门癌前病变的独特组织学类型。

河南食管癌高发区食管和贲门癌组织中PTEN蛋白的表达

目的 :探讨PTEN蛋白在食管鳞癌和贲门腺癌组织中表达变化及其与细胞分化程度及淋巴结转移的关系。方法 :采用免疫组化卵白素 生物素 过氧化物酶复合物 (ABC)法和组织病理学方法 ,分析河南食管癌高发区林州市 14 1例食管鳞癌和贲门腺癌患者PTEN的表达状况。结果 :食管鳞癌和贲门腺癌PTEN阳性率分别为 4 7%(34/73)和 4 3% (2 9/6 8)。随着肿瘤分化程度的升高 ,PTEN蛋白的表达有增高的趋势 ,淋巴结转移组PTEN免疫阳性率较无淋巴结转移组高 ,但统计分析未发现PTEN免疫阳性反应率与分化程度和淋巴结转移间存在相关性(P均大于 0 .0 5 )。结论 :河南食管癌高发区食管鳞癌和贲门腺癌存在一致的PTEN蛋白变化 ,提示

18例食管、贲门癌术后胸胃排空障碍的诊治体会

目的总结食管、贲门癌术后,胸胃排空障碍的原因及处理方法。方法回顾性分析527例食管癌、贲门癌手术患者,其中18例术后发生胸胃排空障碍,分析发生胸胃排空障碍的原因和处理方法。结果18例患者中,12例系功能性胸胃排空障碍,经保守治疗后好转;6例机械性胸胃排空障碍,其中2例经保守治疗后好转,4例经再次开胸手术治疗后好转。结论胸胃排空障碍是食管癌、贲门癌患者术后较常见的并发症,包括功能性和机械性两种,功能性胸胃排空障碍和部分机械性胸胃排空障碍用保守治疗可以好转,多数机械性胸胃排空障碍需再次行开胸手术治疗。

1982年至1999年食管癌、贲门癌低发区和高发区患者TNM分期比较

目的探讨1982年到1999年18a间中国北方城市食管、贲门癌城市低发区与农村高发区居民中新发食管癌与贲门癌患者的肿瘤TNM分期分布特征。方法根据北京同仁医院和河北磁县人民医院的病例资料记录,动态分析这2个医院18a间首次确诊时的食管癌和贲门癌TNM分期,并依据TNM分期,将患者分为早期(TNM0和Ⅰ期),中期(TNMⅡa和Ⅱb期)及晚期(TNMⅢ和Ⅳ期)。结果18a间农村居民患者首次确诊的4928例食管癌(3074例)和贲门癌(1854例)中,早期患者仅占5%和2%,95%以上的患者均为中、晚期。城市居民患者首次确诊的751例食管癌和贲门癌患者中,早期食管癌(14%)和早期贲门癌(10%)均略高于农村患者(P<0.05),但是城市患者中,90%的贲门癌和86%的食管癌患者仍为中、晚期。结论城市低发区和农村高发区首次就诊的食管癌和贲门癌患者仍以中、晚期为主,这是导致食管贲门癌预后差、死亡率高的主要原因。

食管贲门双源癌组织中Rb蛋白的表达

目的:探讨食管贲门双源癌组织中Rb蛋白表达的变化特征及其意义。方法:采用免疫组化ABC法和组织病理学方法,分析河南食管癌高发区林州市30例食管贲门双源癌患者Rb蛋白的表达状况。结果:在30例双源癌患者中,食管鳞癌和贲门腺癌组织中Rb阳性率分别为46.7%(14/30)和40%(12/30),差异无统计学意义(χ2=0.272,P>0.05)。食管和贲门癌组织Rb一致阳性率为36.7%(26/30),一致阴性率为50%(15/30),食管鳞癌和贲门腺癌组织中Rb的表达相关(P<0.05)。结论:该地区食管癌和贲门癌存在较高的Rb一致性变化,提示二者可能具有相似的发病因素和分子机制。

136例高龄食管癌、贲门癌患者的外科手术治疗体会

目的总结>70岁高龄食管癌、贲门癌患者的外科治疗经验。方法回顾性分析2008年1月～2011年4月在我科手术治疗的136例>70岁高龄食管癌、贲门癌患者的临床资料(≥80岁24例)。结果全组均行肿瘤根治术。手术时间(141.5±48.7)min。术后发生吻合口瘘3例,肺不张4例,肺部感染12例,呼吸衰竭9例,急性肾功能衰竭2例,心律失常15例,伤口感染2例,乳糜胸1例;死亡3例,其余均经治疗后痊愈出院。术后平均住院时间(12.3±3.4)d。随访78例,随访1～39个月,10例死亡,其中4例死于肿瘤复发或者远处转移,6例死于心脑血管意外,其余患者生活质量良好。结论在合理掌握适应证的前提下,对>70岁高龄食管癌、贲门癌患者进行积极的手术治疗是安全有效的,但对各种并发症应有充分的认识,同时需要加强围术期管理。

贲门癌瘤体最长直径与临床病理特征的关系及其对患者生存期的影响

目的探讨贲门癌瘤体最长直径(maximum tumor diameter,MTD)与浸润程度、淋巴结转移和分化程度的关系及其对患者生存期的影响,为贲门癌临床病理TNM分期提供依据。方法测量4826例手术治疗的贲门癌患者MTD,分析MTD与肿瘤浸润程度、淋巴结转移和分化程度的关系;对其中1 756例患者进行入户问卷调查、和(或)电话随访,采用Kaplan-Meier法计算其生存期并绘制生存曲线,Log rank检验分析组间生存期的差异,Cox比例风险回归模型分析MTD对患者生存期的影响。结果 4 826例贲门癌患者平均MTD为(5.6±2.3)cm,MTD中位数为5.0 cm(0.5~18.0 cm)。依MTD长度,将贲门癌患者分为四组(MTD【3 cm、3~6 cm、≥6~9 cm、≥9 cm)。随MTD增长,患者淋巴结转移阳性率明显升高(r=0.254,P【0.05),浸润程度逐渐加深(r=0.102,P【0.05),癌细胞分化程度变差(r=0.069,P【0.05);5年生存率明显降低(P【0.05)。特别需要指出的是,随MTD增长,淋巴结转移阴性组患者5年生存率也明显降低。Cox多因素生存分析发现,MTD、淋巴结转移、浸润程度和分化程度是影响贲门癌患者预后的独立因素。结论贲门癌MTD与淋巴结转移、肿瘤细胞浸润程度和分化程度密切相关;是影响贲门癌患者预后的独立因素。

贲门癌手术切缘癌残留相关因素分析

目的:分析贲门癌切除手术后切缘镜下癌残留相关原因,为提高贲门癌外科治疗效果总结经验。方法:回顾性分析我院1995～2005年间收治的123例贲门癌临床资料,应用单因素分析方法探讨贲门癌切除手术上下切缘癌残留的相关因素。结果:123例贲门癌术后病理诊断切缘镜下癌残留11例,上切缘残留5例,下切缘残留6例,上下切缘均残留1例,残留率8.9%,切缘癌残留者与切缘无癌残留肿瘤最长径分别为9.5±3.8cm和6.5±3.1cm,P<0.05;不同肿瘤大小、不同TNM分期的切缘癌残留发生率有明显统计学差异(P<0.05),贲门癌肿瘤最长径>7cm以及TNM分期为Ⅳ期是切缘癌残留的危险因素。结论:在贲门癌外科治疗中,根据肿瘤最长径来决定贲门癌手术切除范围及术式以减少切缘癌残留有重要临床价值:肿瘤最长径超过7cm,肿瘤TNM分期至Ⅳ期患者应行全胃切除术,并保证足够长度的上切缘以减少切缘癌残留发生。

河南食管癌高发区食管贲门双源癌粘蛋白1、C-erbB2蛋白的表达

目的 :探讨同一个体食管贲门双源癌组织粘蛋白 1(MUC1)和C erbB2蛋白变化的特征及其意义。方法 :采用免疫组化卵白素 生物素 过氧化物酶复合物 (ABC)法和组织病理学方法 ,分析河南食管癌高发区 2 5例双源癌患者 (同时发生食管鳞癌和贲门腺癌 )MUC1和C erbB2蛋白的表达状况。结果 :2 5例患者食管鳞癌和贲门腺癌组织均出现不同程度的MUC1和C erbB2蛋白的阳性表达。食管癌 :MUC1,C erbB2免疫阳性率分别为 80 %(2 0 / 2 5 ) ,2 0 % (5 / 2 5 ) ;贲门癌 :分别为 72 % (18/ 2 5 ) ,4 8% (12 / 2 5 ) ,且免疫反应类型均主要为弥漫型。MUC1,C erbB2蛋白在食管和贲门双源癌肿瘤组织中具有很高的一致性改变 ,一致性改变率分别为 92 %、6 4 %。结论 :食管和贲门双源癌存在较高的MUC1和C erbB2蛋白一致性改变 。

北京大学人民医院10年住院患者胃癌临床资料分析

目的总结该院近10年来住院患者胃癌的临床资料特点及变化趋势,比较青年人与老年人胃癌、贲门癌与非贲门癌的异同,为疾病的诊治与评估提供帮助。方法将1999年1月～2009年1月于该院病理诊断并住院治疗的胃癌患者(共计656例)列为研究对象,进行回顾性分析:①对其平均年龄、性别比例、病理类型、发生部位、TNM分期等进行统计。②对青年人(≤40岁)与老年人(≥60岁)胃癌临床资料进行比较:以χ2检验分析二者在性别比例、病理类型、发生部位、TNM分期、家族史方面有无差异。③对贲门癌与非贲门癌临床资料进行比较:以秩和检验分析二者在发病年龄上有无差异,以χ2检验分析二者在性别比例、病理类型、TNM分期、家族史方面有无差异。结果①656例胃癌中,男性占70.7%(464例),女性占29.3%(192例),平均年龄(62.1±12.9)岁(中位年龄64.5岁)。病理类型以低分化腺癌居多(359例),占57.3%。发生部位以胃窦部居多(304例),占46.3%,贲门癌占9.8%(64例)。贲门癌所占比例无明显上升趋势。早癌占12.3%(81例),进展期癌占87.7%(575例)。TNM分期以III、IV期居多,分别占33.0%(193例)和34.8%(203例)。年龄分层看出,34岁以后患者比例逐渐升高,以64～74岁年龄段所占比例最大。前5年(1999～2003年)胃癌患者平均年龄(61.1±13.7)岁,后5年(2004～2008年)平均年龄(63.1±11.9)岁,差异有统计学意义。②青年人胃癌中男女比例为1:1,老年人胃癌为3:1,差异有统计学意义;病理类型上,青年人胃癌高度恶性组(低分化腺癌+印戒细胞癌)占97.7%,老年人胃癌高度恶性组占71.6%,差异有统计学意义;二者在肿瘤发生部位、TNM分期、肿瘤家族史上差异无统计学意义。③贲门癌平均年龄(65.6±11.1)岁,非贲门癌平均年龄(61.8±12.8)岁,差异有统计学意义;贲门癌男女比例为5.4:1.0,非贲门癌为2.3:1.0,差异有统计学意义;TNM分期上,贲门癌IV期占52.6%,非贲门癌IV期占29.2%,差异有统计学意义;二者在病理类型、肿瘤家族史上差异无统计学意义。结论①胃癌好发于老年、男性,以低分化腺癌、胃窦部多见,就诊时TNM分期以III、IV期多见。近10年来该院住院患者贲门癌所占比例未见明显上升趋势,后5年(2004～2008年)胃癌患者较前5年(1999～2003年)平均年龄增大。②与老年人胃癌相比,青年人胃癌中女性比例相对较高,恶性程度更高。二者在肿瘤发生部位、TNM分期、肿瘤家族史上差异无统计学意义。③与非贲门癌相比,贲门癌发病年龄更大,男性比例更高,TNM分期中IV期更多见。二者在病理类型、肿瘤家族史上差异无统计学意义。