108例年轻胃癌患者临床病理特征分析
Clinicopathological features of gastric cancer in 108 young patients

摘要：目的 探讨年轻胃癌患者的临床、病理和预后特征。方法 回顾性收集兰州大学第一医院2012-2017年所有胃癌患者，将发病年龄用五分位间距法对年轻胃癌和中老年胃癌进行区分(45岁被确定为年轻胃癌和中老年胃癌的年龄截断值)，分析两组的人口学、临床病理、分子病理和预后特征。结果 分析所获取的年轻胃癌组(n=108)和中老年胃癌组(n=216)患者的性别信息，性别比分别为1.4∶1和3.5∶1(P<0.001)；年轻胃癌和中老年胃癌家族史的比例分别为8.33%和2.78%，但差异无统计学意义(P=0.062)；与中老年患者组相比，年轻患者组以胃窦部发生病变为主，多部位发生更为常见，更多胃溃疡病史，诊断所需时间更长，以低分化腺癌为主，印戒细胞癌比例较高，Borrmann Ⅲ型和Ⅳ型更为多见，生存时间更短(P<0.05)。但两组在Her-2、雌激素受体(ER)、孕激素受体(PR)和EB病毒相关RNA(EBER)表达方面未见差异(P>0.05)。结论 年轻胃癌患者在性别比例、临床病理及预后特征等方面不同于中老年胃癌患者，恶性度更高，预后更差，可以考虑作为一个独特的临床群体。进一步研究年轻胃癌患者的病因和高危因素具有重要意义。
ABSTRACT: Objective To evaluate the clinicopathological and prognostic features of young patients with gastric cancer. Methods We retrospectively analyzed the age trend of all the inpatients gastric with adenocarcinoma pathologically confirmed from 2012 to 2017 in our institution. The cut-off value of 45 years old to distinguish the young and the middle-aged patients with gastric cancer was defined to be the bottom fifth percentile in the age histogram of all gastric cancer patients. Then we analyzed the demographic, clinicaopathological, molecular pathological and prognostic features of the two groups. Results Based on the age and gender composition of the gastric cancer patients, 45 years was defined as the cut-off age to differentiate the young (n=108) and the middle-aged gastric (n=216) cancer patients. The gender ratio was 1.4∶1 and 3.5∶1 in the young group and the middle-aged group, respectively (P<0.001). Although there was no statistical significance, family history was much more in the young group than in the middle-aged Group (8.33% vs. 2.78%, P=0.062). Otherwise, those young patients always had some distinct features, including delay in diagnosis, primarily in antrum and frequent multifocal sites compared with the middle-aged gastric cancer patients. Furthermore, we found more frequent occurrence of gastric ulcer history, poorly differentiated adenocarcinoma and signet-ring cell carcinoma, Borrmann Ⅲ and Ⅳ typing, and diffuse typing in the young patients. Moreover, less radical gastrectomy and shorter survival were also exhibited (P<0.05). Surprisingly, ER and PR were not detected within gastric cancer tissues with IHC (P>0.05). Conclusion The young patients with gastric cancer exhibits different behavior and can be considered as a unique clinical entity. Further studies are required to fully understand the possible carcinogenesis and risk factors among young gastric cancer patients