青年人与老年人胃癌临床病理特点及对比分析

发布时间：2018-09-13 21:38

【摘要】：目的:通过对青年人与老年人胃癌患者的临床病理特点进行对比分析,探讨青年人胃癌和老年人胃癌的共同点和不同点,从而为胃癌的预防和治疗提供理论依据。方法及资料:分别对青年及老年胃癌患者的性别、临床症状、家族史、肿瘤标志物(CEA)、肿瘤发生部位、胃镜下大体分型、组织学分型、临床分期、手术治疗情况分别进行对比分析。回顾性分析2006年1月至2015年12月吉林大学中日联谊医院收治的112例具有完整临床资料的胃癌患者,均经胃镜病理或术后病理明确诊断,伴有其他原发性恶性肿瘤者不予纳入研究对象。我们将≤30岁患者归为青年组,≥70岁患者归为老年组,其中青年组患者42例,老年组患者70例。统计分析采用SPSS21.0统计学软件,数据差异采用X~2检验,P0.05为差异有统计学意义。结果:(1)性别:青年组女性较男性常见,男女比例为:1:1.3,女性占57.14%;老年组男性较女性多见,男女比例为:2.33:1,男性占70%,两组间男女发病率比较差异有统计学差异(P0.05)。(2)临床症状:青年组和老年组患者均以腹痛为主,青年组患者中约占57.14%,老年组患者中约占80%,两组比较差异具有统计学意义(P0.05);青年组患者中有呕血、黑便症状者占33.33%,老年组占17.14%,其差异比较具有统计学意义(P0.05);老年组患者出现吞咽困难、胸骨后不适、消瘦症状均高于青年组,两组差异比较均具有统计学意义(P0.05);老年组患者出现贫血、食欲减退、腹部包块症状均高于青年组,其它临床症状两组之间比较均无统计学意义(P0.05)。(3)家族史:青年组有家族史者占19.05%,老年组有家族史者占2.86%,两组家族史比较差异有统计学意义(P0.05)。(4)肿瘤标志物:青年组CEA升高者占14.29%,老年组CEA升高者占17.14%,两组比较差异无统计学意义(P0.05)。(5)发病部位:青年组好发部位是胃窦,青年组患者占61.90%,老年组患者占34.29%,其差异比较具有统计学意义(P0.05);青年组胃体部发病率比老年组略低,其差异比较无统计学意义(P0.05);青年组胃底贲门处发病患者占9.52%,低于老年组的37.14%,其差异比较具有统计学意义(P0.05),青年组胃广泛癌发病率比老年组略高,两组差异比较无统计学意义(P0.05)。(6)胃镜下大体分型:青年组以Borrmann Ⅲ、Borrmann Ⅳ型为主,老年组以Borrmann II、Borrmann Ⅲ型为主,其中青年组Borrmann Ⅳ型的构成比为33.33%,高于老年组的17.14%,其差异进行统计学处理具有意义(P0.05);青年组Borrmann I型患者占4.76%,明显低于老年组的18.57%,其差异进行统计学处理具有意义(P0.05)。Borrmann II、Borrmann Ⅲ型两组比较差异均无统计学意义(P0.05)。(7)组织学分型:青年组低分化腺癌、印戒细胞癌的比例分别为42.86%、16.67%,高于老年组的17.14%、4.29%,两组分别比较差异都具有统计学意义(P0.05);青年组高分化腺癌、中分化腺癌患者分别占4.76%、9.52%,低于老年组的18.57%、34.29%,两组比较差异都具有统计学意义(P0.05);粘液腺癌、未分化癌及其他特殊类型癌分别进行数据处理,都没有统计学意义(P0.05)。(8)临床分期:青年组以Ⅲ、Ⅳ期为主,老年组II、Ⅲ、Ⅳ期均常见。其中青年组Ⅳ期患者约45.24%,明显高于老年组的25.71%,其差异比较具有统计学意义(P0.05);青年组II期患者约占9.52%,明显低于老年组的25.71%,比较差异具有统计学意义(P0.05)。I、Ⅲ期患者所占比例两组比较差异都没有统计学意义(P0.05)。(9)手术治疗情况:青年组和老年组患者接受手术治疗者分别占76.19%、80%,其差异无统计学意义(P0.05);青年组接受根治性手术的占47.62%,低于老年组的67.14%,青年组接受姑息手术的占28.57%,高于老年组的12.86%,两组比较差异均具有统计学意义(P0.05)。结论:1.青年胃癌患者女性较常见,老年胃癌患者男性为主,青年胃癌患者有较多的家族史。2.青年胃癌患者以胃窦多见,以消化道出血为主要表现;老年组胃癌以胃底贲门多见,消化功能障碍为主要表现。3.青年胃癌病理分型较差,分期较晚,获得根治性手术比例较低。
[Abstract]:Objective:To explore the similarities and differences between young and old patients with gastric cancer by comparing the clinicopathological characteristics of young and old patients, so as to provide theoretical basis for the prevention and treatment of gastric cancer. A retrospective analysis of 112 cases of gastric cancer with complete clinical data admitted to the Sino-Japanese Friendship Hospital of Jilin University from January 2006 to December 2015 was made. Patients with other primary malignant tumors were not included in the study. We classified the patients younger than 30 years old into the youth group and those older than 70 years old into the elderly group, including 42 cases in the youth group and 70 cases in the elderly group. Young women were more common than men, the ratio of male to female was 1:1.3, women accounted for 57.14%; elderly men were more common than women, the ratio of male to female was 2.33:1, male accounted for 70%. There was a significant difference between the two groups in the incidence of male and female (P 0.05). (2) Clinical symptoms: young group and elderly group were mainly abdominal pain, young group accounted for 57.14%, elderly group about 57.14%. The difference between the two groups was statistically significant (P 0.05); 33.33% of the young group had hematemesis, and 17.14% of the elderly group had melena symptoms; the difference was statistically significant (P 0.05); the elderly group had dysphagia, sternal discomfort, and wasting symptoms were higher than the young group; the differences between the two groups were statistically significant (P 0.05). (3) Family history: 19.05% of the young group had family history, 2.86% of the elderly group had family history, and there was a significant difference between the two groups in family history (P 0.05). (4) Swelling. Tumor markers: 14.29% of the young group increased CEA, 17.14% of the elderly group increased CEA, there was no significant difference between the two groups (P There was no significant difference between the two groups (P 0.05). The incidence of extensive gastric cancer in the youth group was slightly higher than that in the elderly group (P 0.05). There was no significant difference between the two groups (P 0.05). The incidence of extensive gastric cancer in the youth group was 9.52% and 37.14% respectively. The proportion of Borrmann type IV in young group was 33.33%, which was higher than 17.14% in old group. The difference was statistically significant (P 0.05). The proportion of Borrmann type I in young group was 4.76%, which was significantly lower than 18.57% in old group. Significance (P 0.05). There was no significant difference between Borrmann II and Borrmann III (P 0.05). (7) Histological classification: the proportion of poorly differentiated adenocarcinoma and signet ring cell carcinoma in young group was 42.86%, 16.67% respectively, higher than that in old group (17.14%, 4.29%). There was significant difference between the two groups (P 0.05). Patients with moderately differentiated adenocarcinoma accounted for 4.76%, 9.52%, lower than 18.57%, 34.29% of the elderly group, the difference between the two groups was statistically significant (P 0.05); mucinous adenocarcinoma, undifferentiated carcinoma and other special types of cancer data processing, respectively, were not statistically significant (P 0.05). (8) Clinical stage: Youth group with stage III, IV mainly, the elderly group with stage II, III, IV. The youth group stage IV patients were 45.24%, significantly higher than the elderly group 25.71%, the difference was statistically significant (P 0.05); youth group stage II patients accounted for 9.52%, significantly lower than the elderly group 25.71%, the difference was statistically significant (P 0.05). I, the proportion of patients with stage II I between the two groups was not statistically significant (P 0.0). (9) Surgical treatment: 76.19% of the youth group and 80% of the elderly group received surgical treatment, the difference was not statistically significant (P 0.05); 47.62% of the youth group received radical surgery, lower than 67.14% of the elderly group; 28.57% of the youth group received palliative surgery, higher than 12.86% of the elderly group; the difference between the two groups was statistically significant. Significance (P 0.05). Conclusion: 1. Young patients with gastric cancer are more common in women, elderly patients with gastric cancer are mainly male, young patients with gastric cancer have more family history. 2. Young patients with gastric cancer are more common in gastric antrum, with gastrointestinal bleeding as the main manifestation; elderly patients with gastric cancer are more common in gastric fundus and cardia, digestive dysfunction as the main manifestation. Later, the rate of radical surgery was relatively low.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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