Theuer C P, de Virgilio C, Keese G, French S, Arnell T, Tolmos J, Klein S, Powers W, Oh T, Stabile B E
Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509, USA.
Am J Surg. 1996 Nov;172(5):473-6; discussion 476-7. doi: 10.1016/S0002-9610(96)00223-1.
Gastric adenocarcinoma is considered a disease of the middle aged and elderly and has been infrequently reported in patients under 40 years of age. The purpose of this study was to determine the proportion of young patients diagnosed with gastric adenocarcinoma and to compare the demographic, clinical and pathologic features of younger and older patients with gastric adenocarcinoma.
A retrospective cohort study using tumor registry records of all patients with gastric adenocarcinoma diagnosed from 1982 through 1996 at a public teaching hospital. Demographic, clinical, and pathologic comparisons were made between patients younger than 41 years of age and race- and sex-matched older patients with gastric adenocarcinoma.
Thirty of 203 (15%) cases of gastric adenocarcinoma were diagnosed in patients less than 41 years (range 23 to 40). Male to female ratio was 1:1. Young patients were more likely to be black (33% versus 17%, P = 0.04) Both younger and older patients presented with advanced disease, with nearly half of each group having metastases. Twelve of 29 (41%) younger patients were operated on without a histologic diagnosis of gastric adenocarcinoma in contrast to only 1 older patient (P < 0.001). One of 30 (3%) young patients is alive 39 months following gastrectomy. Twenty patients died and the remaining 9 were lost to follow-up, all with known residual or recurrent disease. Six-month survival of young patients (23%) was less than older patients (42%) (P = 0.14). Young patients were more likely to have diffuse histology (80% versus 55%, P = 0.12). Overt infection with Helicobacter pylori was uncommon in both groups.
Young patients accounted for an unusually high proportion of patients with gastric adenocarcinoma diagnosed at our public teaching hospital. Young patients were significantly more likely to be black and less likely to have an accurate preoperative histologic diagnosis. Both young and older patients presented with advanced disease and had poor survival. Young patients were more likely to have diffuse histology and had poorer 6-month survival, suggesting a more aggressive variety of the disease in this group.
胃腺癌被认为是一种中老年疾病，在40岁以下患者中鲜有报道。本研究的目的是确定被诊断为胃腺癌的年轻患者的比例，并比较年轻和老年胃腺癌患者的人口统计学、临床和病理特征。
一项回顾性队列研究，使用了1982年至1996年在一家公立教学医院诊断的所有胃腺癌患者的肿瘤登记记录。对年龄小于41岁的患者与年龄、种族和性别匹配的老年胃腺癌患者进行了人口统计学、临床和病理比较。
203例胃腺癌患者中有30例（15%）年龄小于41岁（范围23至40岁）。男女比例为1:1。年轻患者更可能是黑人（33%对17%，P = 0.04）。年轻和老年患者均表现为晚期疾病，每组近一半有转移。29例年轻患者中有12例（41%）在未获得胃腺癌组织学诊断的情况下接受了手术，而老年患者只有1例（P < 0.001）。30例年轻患者中有1例（3%）在胃切除术后39个月存活。20例患者死亡，其余9例失访，均有已知的残留或复发性疾病。年轻患者的6个月生存率（23%）低于老年患者（42%）（P = 0.14）。年轻患者更可能有弥漫性组织学类型（80%对55%，P = 0.12）。两组中幽门螺杆菌的显性感染均不常见。
在我们的公立教学医院诊断的胃腺癌患者中，年轻患者所占比例异常高。年轻患者显著更可能是黑人，且术前获得准确组织学诊断的可能性较小。年轻和老年患者均表现为晚期疾病，生存率低。年轻患者更可能有弥漫性组织学类型，6个月生存率更低，提示该组疾病更具侵袭性。
