AIM:To understand the clinicopathological and prognostic features of gastric cancer in younger and older patients.METHODS:Between January 2002 and December2008,1667 patients underwent curative gastric surgery.For comp...AIM:To understand the clinicopathological and prognostic features of gastric cancer in younger and older patients.METHODS:Between January 2002 and December2008,1667 patients underwent curative gastric surgery.For comparative purposes,the patients were divided into two groups:younger patients who were less than 40 years old(112 patients),and older patients who were 40 years old and older(1555 patients).In both groups,propensity scoring methods were used to select patients with similar disease statuses.A total of224 matched cases,with 112 patients in each group,were included in the final analysis.RESULTS:Compared to the older group,the younger group with gastric cancer had a significantly higher percentage of females(P=0.007),poorly differentiated or signet ring cell carcinoma(P<0.001),advanced T stage gastric cancer(P=0.045),and advanced tumornode-metastasis stage cancer(P=0.036).The older group with gastric cancer had more comorbidities(P<0.001).With the exception of the number of lymph node dissection(P<0.001)and retrieved lymph node(P=0.010),there were no statistically significant differences between the postoperative outcomes of the two groups.During the follow-up period,there were19 recurrences in the younger group and 11 recurrences in the older group.The overall five-year survival rates in the younger and older groups were 84.3%and89.6%,respectively(P=0.172).There were no significant differences(P=0.238)in the overall survival of patients with advanced T stage gastric cancer in the two groups,with five-year survival rates of 70.8%in the younger group and 79.5%in the older group.With regard to the age-adjusted survival rate,there was significant difference between the two groups(P=0.225).CONCLUSION:In spite of aggressive cancer patterns in the younger group with gastric cancer,the younger group did not have a worse prognosis than the older group in our study.展开更多
BACKGROUND The impact of racial and regional disparity on younger patients with gastric cancer(GC) remains unclear.AIM To investigate the clinicopathological characteristics, prognostic nomogram, and biological analys...BACKGROUND The impact of racial and regional disparity on younger patients with gastric cancer(GC) remains unclear.AIM To investigate the clinicopathological characteristics, prognostic nomogram, and biological analysis of younger GC patients in China and the United States.METHODS From 2000 to 2018, GC patients aged less than 40 years were enrolled from the China National Cancer Center and the Surveillance Epidemiology and End Results database. Biological analysis was performed based on the Gene Expression Omnibus database. Survival analysis was conducted via Kaplan-Meier estimates and Cox proportional hazards models.RESULTS A total of 6098 younger GC patients were selected from 2000 to 2018, of which 1159 were enrolled in the China National Cancer Center, and 4939 were collected from the Surveillance Epidemiology and End Results database. Compared with the United States group, younger patients in China revealed better survival outcomes(P < 0.01). For race/ethnicity, younger Chinese cases also enjoyed a better prognosis than that in White and Black datasets(P < 0.01). After stratification by pathological Tumor-Node-Metastasis(pTNM) stage, a survival advantage was observed in China with pathological stage Ⅰ, Ⅲ, and Ⅳ(all P < 0.01), whereas younger GC patients with stage Ⅱ showed no difference(P = 0.16). In multivariate analysis, predictors in China involved period of diagnosis, linitis plastica, and pTNM stage, while race, diagnostic period, sex, location, differentiation, linitis plastica, signet ring cell, pTNM stage, surgery, and chemotherapy were confirmed in the United States group. Prognostic nomograms for younger patients were established, with the area under the curve of 0.786 in the China group and of 0.842 in the United States group. Moreover, three gene expression profiles(GSE27342, GSE51105, and GSE38749) were enrolled in further biological analysis, and distinctive molecular characteristics were identified in younger GC patients among different regions.CONCLUSION Except for younger cases with pTNM stage Ⅱ, a survival advantage was observed in the China group with pathological stage Ⅰ, Ⅲ, and Ⅳ compared to the United States group, which might be partly due to differences in surgical approaches and the improvement of the cancer screening in China. The nomogram model provided an insightful and applicable tool to evaluate the prognosis of younger patients in China and the United States. Furthermore, biological analysis of younger patients was performed among different regions, which might partly explain the histopathological behavior and survival disparity in the subpopulations.展开更多
目的:评价全腹腔镜胃癌D2根治术治疗高龄胃癌患者的安全性及对患者生存的分析。方法:采用回顾性病例对照研究的方法,纳入2012年10月到2016年9月在空军军医大学附属唐都医院胃肠外科行手术治疗的70岁以上胃癌患者108例,根据手术方式差异...目的:评价全腹腔镜胃癌D2根治术治疗高龄胃癌患者的安全性及对患者生存的分析。方法:采用回顾性病例对照研究的方法,纳入2012年10月到2016年9月在空军军医大学附属唐都医院胃肠外科行手术治疗的70岁以上胃癌患者108例,根据手术方式差异分为腹腔镜组(n=54)和开腹组(n=54)。收集并分析两组患者的临床病理学资料和术后30天内并发症发生情况及生存状况。结果:两组术前一般特征及术后病理学特征比较未见统计学差异(P>0.05)。与开腹组相比,腹腔镜组术中出血量、围手术期输血更少(69.6±44.6 vs 234.1±110.5,P=0.000;27.8%vs 53.7%,P=0.006),术后首次通气时间早(3.0±1.1 vs 3.8±1.1,P=0.000),且术后住院时间短(7.4±3.4 vs 9.3±4.0,P=0.011)。开腹组术后30天内非腹部并发症发生率更高(29.6%vs 9.3%,P=0.007),但两组腹部并发症(18.5%vs 11.1%,P=0.302)和严重并发症比较(7.4%vs 1.9%,P=0.206)未见统计学差异。腹腔镜组1年、2年及3年累计生存率分别为87.6%、80.1%及58.6%,开腹组1年、2年及3年累计生存率分别为84.8%、68.9%和54.3%,组间比较未见统计学差异(P>0.05)。结论:全腹腔镜D2根治术治疗高龄胃癌患者安全可行,且具有术中出血少、术后首次通气时间早、术后住院时间短的优势,患者术后远期生存情况与传统开腹手术相当。展开更多
基金Supported by The Dong-A University Research Fund
文摘AIM:To understand the clinicopathological and prognostic features of gastric cancer in younger and older patients.METHODS:Between January 2002 and December2008,1667 patients underwent curative gastric surgery.For comparative purposes,the patients were divided into two groups:younger patients who were less than 40 years old(112 patients),and older patients who were 40 years old and older(1555 patients).In both groups,propensity scoring methods were used to select patients with similar disease statuses.A total of224 matched cases,with 112 patients in each group,were included in the final analysis.RESULTS:Compared to the older group,the younger group with gastric cancer had a significantly higher percentage of females(P=0.007),poorly differentiated or signet ring cell carcinoma(P<0.001),advanced T stage gastric cancer(P=0.045),and advanced tumornode-metastasis stage cancer(P=0.036).The older group with gastric cancer had more comorbidities(P<0.001).With the exception of the number of lymph node dissection(P<0.001)and retrieved lymph node(P=0.010),there were no statistically significant differences between the postoperative outcomes of the two groups.During the follow-up period,there were19 recurrences in the younger group and 11 recurrences in the older group.The overall five-year survival rates in the younger and older groups were 84.3%and89.6%,respectively(P=0.172).There were no significant differences(P=0.238)in the overall survival of patients with advanced T stage gastric cancer in the two groups,with five-year survival rates of 70.8%in the younger group and 79.5%in the older group.With regard to the age-adjusted survival rate,there was significant difference between the two groups(P=0.225).CONCLUSION:In spite of aggressive cancer patterns in the younger group with gastric cancer,the younger group did not have a worse prognosis than the older group in our study.
基金National Key R&D Program of China,No.2017YFC0908300.
文摘BACKGROUND The impact of racial and regional disparity on younger patients with gastric cancer(GC) remains unclear.AIM To investigate the clinicopathological characteristics, prognostic nomogram, and biological analysis of younger GC patients in China and the United States.METHODS From 2000 to 2018, GC patients aged less than 40 years were enrolled from the China National Cancer Center and the Surveillance Epidemiology and End Results database. Biological analysis was performed based on the Gene Expression Omnibus database. Survival analysis was conducted via Kaplan-Meier estimates and Cox proportional hazards models.RESULTS A total of 6098 younger GC patients were selected from 2000 to 2018, of which 1159 were enrolled in the China National Cancer Center, and 4939 were collected from the Surveillance Epidemiology and End Results database. Compared with the United States group, younger patients in China revealed better survival outcomes(P < 0.01). For race/ethnicity, younger Chinese cases also enjoyed a better prognosis than that in White and Black datasets(P < 0.01). After stratification by pathological Tumor-Node-Metastasis(pTNM) stage, a survival advantage was observed in China with pathological stage Ⅰ, Ⅲ, and Ⅳ(all P < 0.01), whereas younger GC patients with stage Ⅱ showed no difference(P = 0.16). In multivariate analysis, predictors in China involved period of diagnosis, linitis plastica, and pTNM stage, while race, diagnostic period, sex, location, differentiation, linitis plastica, signet ring cell, pTNM stage, surgery, and chemotherapy were confirmed in the United States group. Prognostic nomograms for younger patients were established, with the area under the curve of 0.786 in the China group and of 0.842 in the United States group. Moreover, three gene expression profiles(GSE27342, GSE51105, and GSE38749) were enrolled in further biological analysis, and distinctive molecular characteristics were identified in younger GC patients among different regions.CONCLUSION Except for younger cases with pTNM stage Ⅱ, a survival advantage was observed in the China group with pathological stage Ⅰ, Ⅲ, and Ⅳ compared to the United States group, which might be partly due to differences in surgical approaches and the improvement of the cancer screening in China. The nomogram model provided an insightful and applicable tool to evaluate the prognosis of younger patients in China and the United States. Furthermore, biological analysis of younger patients was performed among different regions, which might partly explain the histopathological behavior and survival disparity in the subpopulations.
文摘目的:评价全腹腔镜胃癌D2根治术治疗高龄胃癌患者的安全性及对患者生存的分析。方法:采用回顾性病例对照研究的方法,纳入2012年10月到2016年9月在空军军医大学附属唐都医院胃肠外科行手术治疗的70岁以上胃癌患者108例,根据手术方式差异分为腹腔镜组(n=54)和开腹组(n=54)。收集并分析两组患者的临床病理学资料和术后30天内并发症发生情况及生存状况。结果:两组术前一般特征及术后病理学特征比较未见统计学差异(P>0.05)。与开腹组相比,腹腔镜组术中出血量、围手术期输血更少(69.6±44.6 vs 234.1±110.5,P=0.000;27.8%vs 53.7%,P=0.006),术后首次通气时间早(3.0±1.1 vs 3.8±1.1,P=0.000),且术后住院时间短(7.4±3.4 vs 9.3±4.0,P=0.011)。开腹组术后30天内非腹部并发症发生率更高(29.6%vs 9.3%,P=0.007),但两组腹部并发症(18.5%vs 11.1%,P=0.302)和严重并发症比较(7.4%vs 1.9%,P=0.206)未见统计学差异。腹腔镜组1年、2年及3年累计生存率分别为87.6%、80.1%及58.6%,开腹组1年、2年及3年累计生存率分别为84.8%、68.9%和54.3%,组间比较未见统计学差异(P>0.05)。结论:全腹腔镜D2根治术治疗高龄胃癌患者安全可行,且具有术中出血少、术后首次通气时间早、术后住院时间短的优势,患者术后远期生存情况与传统开腹手术相当。
