Fujimoto S, Takahashi M, Ohkubo H, Mutou T, Kure M, Masaoka H, Kobayashi K
Department of Surgery, Social Insurance Funabashi Central Hospital, Japan.
Surgery. 1994 Apr;115(4):516-20.
The clinicopathologic features of advanced gastric cancer have been analyzed in young or older patients; however, with regard to early gastric cancer, it remains unknown whether the features differ between young and older patients. Reported here is an analysis of clinicopathologic characteristics in young and in older patients.
This study is based on a retrospective review of 25 patients less than 40 years of age with early gastric cancer and of 64 patients more than 70 years of age with early gastric cancer. These patients were treated from 1977 through 1991.
Because in the older group there were early double cancers in three patients and quadruple cancers in one, 70 early cancers were present in these 64 patients. Although the young group included a larger percentage of women, the ratio of mucosal cancer to submucosal and the incidence of nodal metastasis did not differ between the groups. Poorly differentiated adenocarcinoma was detected in 13 (52%) of the 25 younger patients, whereas in the older group it was present in 6 cancers (8.6%) alone. The number of metastatic nodes and extent of nodal metastasis were more severe in the young group, but survival rates did not differ between the groups. The depressed type of lesion was present in all patients in the young group, whereas it was only 41 of 70 cancers in the older group.
These findings suggest that early gastric cancer in young adults has aggressive features as based on the histologic pattern, in particular with cancer invasion into the submucosal layer. For these patients nodal extirpation and postoperative adjuvant chemotherapy should be performed in an attempt to prevent lymphatic or hematogenic metastases.
已对年轻或老年患者晚期胃癌的临床病理特征进行了分析；然而，关于早期胃癌，年轻和老年患者的特征是否存在差异仍不清楚。本文报道了对年轻和老年患者临床病理特征的分析。
本研究基于对1977年至1991年期间治疗的25例年龄小于40岁的早期胃癌患者和64例年龄大于70岁的早期胃癌患者的回顾性研究。
由于老年组中有3例早期双癌和1例四重癌，这64例患者中共有70例早期癌。虽然年轻组女性比例较高，但两组之间黏膜癌与黏膜下癌的比例以及淋巴结转移发生率并无差异。25例年轻患者中有13例（52%）检测到低分化腺癌，而老年组仅6例癌症（8.6%）存在低分化腺癌。年轻组的转移淋巴结数量和淋巴结转移范围更为严重，但两组的生存率并无差异。年轻组所有患者均为凹陷型病变，而老年组70例癌症中仅有41例为凹陷型。
这些发现表明，基于组织学模式，年轻成年人的早期胃癌具有侵袭性特征，尤其是癌症侵犯至黏膜下层。对于这些患者，应进行淋巴结切除和术后辅助化疗，以试图预防淋巴或血行转移。
