Zhou Fan, Shi Jiong, Fang Cheng, Zou Xiaoping, Huang Qin
From the Gastroenterology Department (FZ, CF, XZ), Drum Tower Hospital Affiliated to Nanjing University Medical School; Pathology Department (JS, QH), Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China; and Pathology Department (QH), VA Boston Healthcare System and Harvard Medical School, Boston, MA.
Medicine (Baltimore). 2016 Mar;95(9):e2873. doi: 10.1097/MD.0000000000002873.
Little is known about clinicopathological characteristics of gastric carcinoma (GC) in young (≤40 years) Chinese patients. We aimed in this study to analyze those features along with family history and prognostic factors after resection. We retrospectively reviewed all 4671 GC resections (surgical and endoscopic) performed at our center from 2004 to 2014 and identified 152 (3.2%) consecutive young patients. Patient demographics, clinical results, family history, and endoscopic-pathological findings were analyzed along with the older (>41 years) GC controls recruited in the same study period. Clinicopathological factors related to postresection outcomes were assessed statistically. The trend of GC resections in young patients was not changed over the study period. Compared to old GCs, the young GC cohort was predominant in women, positive family history, middle gastric location, the diffuse histology type, shorter duration of symptoms, and advanced stage (pIII+pIV, 53.3%). Radical resection was carried out in 90.1% (n = 137) with a better 5-year survival rate (70.3%) than palliative surgery (0%, n = 15). There was no significant difference in clinicopathological characteristics between familial GC (FGC, n = 38) and sporadic GC (SGC, n = 114) groups. Very young patients (≤ 30 years, n = 38) showed lower Helicobacter pylori (Hp) infection and significantly higher perineural invasion rates, compared to older (31-40 years) patients. Hp infection was more commonly seen in the Lauren's intestinal type and early pT stages (T1+T2). Independent prognostic factors for worse outcomes included higher serum CA 72-4, CA 125 levels, positive resection margin, and stage pIII-pIV tumors. The 5-year survival rate was significantly higher in patients with radical resection than those without. GCs in young Chinese patients were prevalent in women with advanced stages but showed no significant differences in clinicopathology between FGC and SGC groups. High serum CA 72-4 and CA 125 levels may help identify patients with worse outcomes. Radical resection improved postresection survival.
对于中国年轻（≤40岁）胃癌（GC）患者的临床病理特征知之甚少。本研究旨在分析这些特征以及家族史和切除术后的预后因素。我们回顾性分析了2004年至2014年在本中心进行的所有4671例GC切除术（手术和内镜），并确定了152例（3.2%）连续的年轻患者。分析了患者的人口统计学、临床结果、家族史以及内镜病理结果，并与同一研究期间招募的年龄较大（>41岁）的GC对照组进行了比较。对与切除术后结果相关的临床病理因素进行了统计学评估。在研究期间，年轻患者GC切除术的趋势没有变化。与老年GC患者相比，年轻GC队列中女性、家族史阳性、胃中部位置、弥漫性组织学类型、症状持续时间较短以及晚期（pIII + pIV，53.3%）更为常见。90.1%（n = 137）的患者进行了根治性切除，其5年生存率（70.3%）优于姑息性手术（0%，n = 15）。家族性GC（FGC，n = 38）和散发性GC（SGC，n = 114）组之间的临床病理特征没有显著差异。与年龄较大（31 - 40岁）的患者相比，非常年轻的患者（≤30岁，n = 38）幽门螺杆菌（Hp）感染率较低，神经周围侵犯率显著较高。Hp感染在劳伦氏肠型和早期pT阶段（T1 + T2）更为常见。预后较差的独立预测因素包括血清CA 72 - 4、CA 125水平较高、切缘阳性以及pIII - pIV期肿瘤。根治性切除患者的5年生存率显著高于未进行根治性切除的患者。中国年轻患者的GC在晚期女性中较为普遍，但FGC和SGC组之间的临床病理没有显著差异。高血清CA 72 - 4和CA 125水平可能有助于识别预后较差的患者。根治性切除可提高切除术后的生存率。
