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目的对青年与老年胃癌病例的临床、病理及内镜特点进行比较,以指导临床诊断及治疗。方法对48例青年胃癌(≤40岁)和99例老年胃癌(≥65岁)的临床、病理资料进行回顾性比较分析。结果青年组男女比例为1∶1.08,老年组为3.6∶1;青年组与老年组有肿瘤家族史者分别为15例(37.5%)及12例(16.7%),差异有统计学意义(P<0.05);两组肿瘤发生部位均以远端胃为主,而老年组胃底、贲门部明显增多,占14.3%,与青年组相比差异有统计学意义(P<0.05);进展期胃癌Borrmann分型均以Ⅲ型居多,但两组Ⅲ型、Ⅳ型总和所占比例差异有统计学意义(P<0.05);两组幽门螺杆菌感染率无统计学意义(P>0.05);青年胃癌组织学以低分化腺癌、黏液腺癌、印戒细胞癌和未分化癌为主(72.9%),Lauren分型以弥漫型为主,较老年组分化程度更差,恶性度高;钡餐检查较胃镜检查更易误诊青年胃癌(P<0.05);11例早期胃癌5年生存率为100%。进展期胃癌根治术后两组生存率差异无统计学意义(P>0.05),中位生存期青年组(28.2个月,95%CI19.8～41.3)较老年组(26.7个月,95%CI21.0～39.8)略长,但差异无统计学意义(P>0.05)。结论青年胃癌较老年有更明显遗传倾向。病理组织学分化程度差,多为弥漫型。若能行根治手术,与老年胃癌预后无统计学差异。
Objective To compare the clinical, pathological and endoscopic features of young and old patients with gastric cancer to guide clinical diagnosis and treatment. Methods The clinical and pathological data of 48 cases of young gastric cancer (≤40 years old) and 99 cases of elderly gastric cancer (≥65 years old) were analyzed retrospectively. Results The male-female ratio was 1: 1.08 in the youth group and 3.6: 1 in the elderly group. There were 15 cases (37.5%) and 12 cases (16.7%) in the youth group and the elderly group, respectively, with statistically significant differences <0.05). The main tumor sites of the two groups were distal stomach, while the gastric fundus and cardia were significantly increased in the elderly group (14.3%), which were significantly different from those in the youth group (P <0.05) The Borrmann classification of gastric cancer was mostly type Ⅲ, but there was a significant difference in the proportion of type Ⅲ and type Ⅳ between the two groups (P <0.05). The infection rate of Helicobacter pylori in the two groups was not statistically significant (P> 0.05). The histological features of young patients with poorly differentiated adenocarcinoma, mucinous adenocarcinoma, signet-ring cell carcinoma and undifferentiated carcinoma (72.9%), Lauren type diffuse type, worse than the older group of high degree of malignancy; Barium meal examination more easily misdiagnosed than gastroscopy in young patients with gastric cancer (P <0.05); 5 cases of early gastric cancer in 11 cases survival rate was 100%. There was no significant difference in survival rate between the two groups after radical gastrectomy (P> 0.05). The median survival time was 28.2 months (95% CI 19.8 ~ 41.3) in the elderly group (26.7 months, 95% CI21.0 ~ 39.8) slightly longer, but the difference was not statistically significant (P> 0.05). Conclusions Youth gastric cancer has a more obvious genetic predisposition than the elderly. Histopathological differentiation is poor, mostly diffuse. If radical surgery can be performed, there is no significant difference between the prognosis of elderly patients with gastric cancer.