Kath R, Fiehler J, Schneider C P, Höffken K
Klinik und Poliklinik für Innere Medizin II, Friedrich-Schiller Universität Jena, Germany.
J Cancer Res Clin Oncol. 2000 Apr;126(4):233-7. doi: 10.1007/s004320050038.
Whether gastric cancer in young adults differs from gastric cancer in older patients has been a controversial issue. It has long been suspected that young patients with gastric cancer have different biological features with a more aggressive course of disease and a poorer prognosis than older patients. This, however, has not been firmly substantiated. We report on the clinical course of four patients (three female and one male) with locally advanced (n = 1) or metastasized (n = 3) non-resectable gastric cancer diagnosed under the age of 29 years (23, 25, 27, 28 years). Prior to diagnosis, all three women had recently been pregnant (1-22 months). Diagnosis was endoscopically biopsy-proven and staging work-up was performed by primary explorative surgery (n = 1), laparoscopy and explorative surgery (n = 1) or CAT scan and ultrasound (n = 2). The delay between initial symptoms and diagnosis was 8-22 weeks (median, 10 weeks). The histology was signet-ring cell (n = 2) or undifferentiated (n = 2) gastric cancer. All patients had the diffuse type of gastric cancer according to Lauren. Patients were treated with the FLAP polychemotherapy regimen consisting of leucovorin, 5-fluorouracil, doxorubicin and cisplatinum, as previously reported. The best response after chemotherapy was partial in two patients. Two patients showed progressive disease. Secondary surgery was performed in three responding patients (one of them responded only locally). One patient achieved no evidence of disease after complete tumor resection (R0). In two patients surgery was palliative (R2/exploration). Three patients died 6, 4 and 8 months after diagnosis. One patient is still alive. In our series, very young adults with gastric cancer had adverse clinical and pathological features. In accordance with other reports, we observed a predominance of female patients and a possible association with recent pregnancies. Though the delay between the first symptoms and diagnosis in our patients was no different from that reported for older patients, special emphasis should be given to prompt referral and diagnostic investigations, ensuring the diagnosis of gastric cancer early in the course of disease.
青年胃癌与老年患者的胃癌是否存在差异一直是个有争议的问题。长期以来，人们一直怀疑青年胃癌患者具有不同的生物学特征，其病程更具侵袭性，预后比老年患者更差。然而，这一点尚未得到确凿证实。我们报告了4例（3例女性和1例男性）年龄在29岁以下（23、25、27、28岁）诊断为局部晚期（n = 1）或转移性（n = 3）不可切除胃癌患者的临床病程。在诊断之前，所有3名女性最近都怀孕过（1 - 22个月）。诊断通过内镜活检证实，分期检查通过初次探查手术（n = 1）、腹腔镜检查和探查手术（n = 1）或计算机断层扫描和超声检查（n = 2）进行。初始症状与诊断之间的延迟为8 - 22周（中位数为10周）。组织学类型为印戒细胞癌（n = 2）或未分化癌（n = 2）。根据劳伦分类，所有患者均为弥漫型胃癌。如先前报道，患者接受了由亚叶酸钙、5 - 氟尿嘧啶、阿霉素和顺铂组成的FLAP多药化疗方案。化疗后的最佳反应在2例患者中为部分缓解。2例患者病情进展。3例有反应的患者接受了二次手术（其中1例仅局部有反应）。1例患者在肿瘤完全切除（R0）后无疾病证据。2例患者的手术为姑息性手术（R2/探查）。3例患者在诊断后6、4和8个月死亡。1例患者仍然存活。在我们的系列研究中，非常年轻的胃癌患者具有不良的临床和病理特征。与其他报告一致，我们观察到女性患者占多数，并且可能与近期怀孕有关。尽管我们患者中首次症状与诊断之间的延迟与老年患者报告的情况没有差异，但应特别强调及时转诊和诊断性检查，确保在疾病早期诊断出胃癌。
