CAJ | 학술논문

目的探讨青年胃癌的临床病理及预后特征,以提高青年胃癌的治疗水平.方法回顾性分析福建医科大学附属协和医院胃外科2004年1月至2006年12月间收治的63例青年胃癌患者(青年组,小于或等于40岁)的临床病理资料及预后情况,并与同期654例中老年胃癌患者(中老年组,大于40岁)进行比较.结果青年组中女性、存在家族史及未分化型患者比例显著高于中老年组(均P＜0.05).青年组患者根治性切除率61.9％(39/63),低于中老年组的93.1％(595/654),差异有统计学意义(P＜0.01).653例(91.1％)患者获得了1～84个月的随访,青年组和中老年组术后5年生存率分别为40.5％和55.6％,差异有统计学意义(P＜0.05).多因素预后分析显示,浸润深度、淋巴结转移和手术根治性是影响青年胃癌患者预后的独立因素(均P＜0.05).分层预后分析显示,行根治性手术的青年组和中老年组患者术后5年生存率分别为63.2％和56.7％,差异无统计学意义(P＞0.05);行姑息性手术后两组患者5年生存率分别为4.2％和22.2％,差异有统计学意义(P＜0.05).结论青年胃癌恶性度高,根治性切除率低,总体预后不佳;但积极行根治性手术者可达到与中老年胃癌相似的远期疗效.
목적 탐토청년위암적림상병리급예후특정,이제고청년위암적치료수평.방법 회고성분석복건의과대학부속협화의원위외과2004년1월지2006년12월간수치적63례청년위암환자(청년조,소우혹등우40세)적림상병리자료급예후정황,병여동기654례중노년위암환자(중노년조,대우40세)진행비교.결과 청년조중녀성、존재가족사급미분화형환자비례현저고우중노년조(균P＜0.05).청년조환자근치성절제솔61.9％(39/63),저우중노년조적93.1％(595/654),차이유통계학의의(P＜0.01).653례(91.1％)환자획득료1～84개월적수방,청년조화중노년조술후5년생존솔분별위40.5％화55.6％,차이유통계학의의(P＜0.05).다인소예후분석현시,침윤심도、림파결전이화수술근치성시영향청년위암환자예후적독립인소(균P＜0.05).분층예후분석현시,행근치성수술적청년조화중노년조환자술후5년생존솔분별위63.2％화56.7％,차이무통계학의의(P＞0.05);행고식성수술후량조환자5년생존솔분별위4.2％화22.2％,차이유통계학의의(P＜0.05).결론 청년위암악성도고,근치성절제솔저,총체예후불가;단적겁행근치성수술자가체도여중노년위암상사적원기료효.
Objective To investigate the clinicopathologic features and prognosis of gastric cancer in young patients (YGC) in order to improve the treatment outcome of YGC.Methods Clinical data of 63 YGC patients (40 years of age and less) who underwent surgery from January 2004 to December 2006 were analyzed retrospectively.A total of 654 older gastric cancer patients (OGC,above 40 years) during the same period patients were selected and compared to the YGC patients.Results The proportions of female patients,patients with a family history or with undifferentiated tumor in YGC were significantly higher than OGC (all P＜0.05).The curative resection rate of YGC patients was 61.9％ (39/63),significandy lower than that of OGC(93.1％,595/654,P＜0.01).A total of 653(91.1％) patients were followed up,with a period of time of 1 to 84 months.The 5-year survival rates for YGC and OGC patients were 40.5％ and 55.6％ respectively,and the difference was statistically significant (P＜0.05).Cox proportional hazards model showed that the depth of invasion,lymph node metastasis,and radical surgery were the independent factors associated with the prognosis of YGC (all P＜0.05).The stratified analysis showed that the 5-year survival rates for YGC and OGC patients undergoing radical surgery were 63.2％ and 56.7％ respectively and the difference was not statistically significant (P＞0.05).The 5-year survival rates for YGC and OGC patients undergoing palliative surgery were 4.2％and 22.2％ respectively and the difference was statistically significant(P＜0.05).Conclusion Gastric cancer in young patients is highly malignant,with lower rate of curative resection and poorer prognosis.The long-term outcome of YGC is similar to that of OGC if radical resection is possible.