【年轻早发性胃癌患者年龄分界点及预后分析】。

Q3 Medicine
J Lu, C B Lv, L Y Tong, J Chen, J N Wu, F L Liu
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引用次数: 0

摘要

目的:探讨年轻早发性胃癌的最佳诊断年龄及预后。方法:回顾性收集2013年1月至2018年12月复旦大学上海肿瘤中心胃外科接受根治性胃切除术的年龄≤45岁胃腺癌患者的临床病理资料。排除远处转移、其他恶性肿瘤、联合脏器切除、残肢癌、切缘阳性、临床或随访资料不完整的患者。对所收集病例的实际总生存期进行X-tile软件分析,得出最佳截止时间为32年。据此,将入组病例分为早发青壮年组(年龄≤32岁)和青壮年组(年龄bb ~ 32岁)。比较两组患者的临床病理特征、长期生存及术后复发率。采用Cox比例风险模型进行单因素和多因素分析,确定影响年轻胃癌患者预后的因素。结果:研究队列共纳入462例患者,其中女性患者256例(55.4%),中下层胃癌患者419例(90.7%),低分化肿瘤患者343例(74.2%)。早发青年组101例,青壮年组361例。这些组在性别、体重指数、肿瘤位置、肿瘤大小、手术方式、神经血管侵犯或肿瘤分期方面无显著差异(均P < 0.05)。早发年轻组低分化肿瘤患者比例显著高于青年组(89.1%[90/101]比70.1%[253/361],χ2=15.26, PP=0.002, 70.6%比55.4%,P=0.004)。Cox多因素分析显示,年龄0 ~ 32岁(HR=0.63, 95%CI: 0.43 ~ 0.90, P=0.012)是术后总生存的独立保护因素,而晚期N期(HR=1.67, 95%CI:1.09 ~ 2.57, P=0.018)是术后总生存的独立危险因素(P32岁(HR=0.60, 95%CI: 0.41 ~ 0.86, P=0.006)也是无病生存的独立保护因素,晚期N期是独立危险因素(HR=1.69, 95%CI: 1.08 ~ 2.64, P=0.021)。结论:年龄≤32岁的年轻早发胃癌患者肿瘤分化及预后较差。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Analysis of age cut-off and prognosis of early-onset gastric cancer in young patients].

Objective: To explore the optimal age cutoff for diagnosis and the prognosis of early-onset gastric cancer in young patients. Methods: Clinicopathological data of patients with gastric adenocarcinoma aged ≤45 years who had undergone radical gastrectomy in the Department of Gastric Surgery, Fudan University Shanghai Cancer Center from January 2013 to December 2018 were retrospectively collected. Patients with distant metastases, other malignant tumors, combined organ resection, gastric stump cancer, positive margin, and incomplete clinical or follow-up data were excluded. X-tile software analysis of the actual overall survival of the collected cases yielded an optimal cut-off of 32 years. Accordingly, the enrolled cases were divided into an early-onset young group (age ≤32 years) and young adult group (age >32 years). Clinicopathological characteristics, long-term survival, and postoperative recurrence were compared between the two groups. Univariate and multivariate analyses were performed using the Cox proportional hazards model to identify the factors affecting the prognosis of young patients with gastric cancer. Results: The study cohort comprised 462 patients, including 256 (55.4%) women, 419 (90.7%) with middle and lower gastric cancers, and 343 (74.2%) with poorly differentiated tumors. There were 101 patients in the early-onset young group and 361 in the young adult group. These groups did not differ significantly in terms of sex, body mass index, tumor location, tumor size, surgical procedure, neurovascular invasion, or tumor stage (all P>0.05). The proportion of patients with poorly differentiated tumors in the early-onset young group was significantly higher than that in the young adult group (89.1%[90/101] vs. 70.1%[253/361], χ2=15.26, P<0.001). All study patients completed 5 years of follow-up, the median duration of which was 101 months (61-133 months). Death or tumor recurrence occurred in 151 patients (32.7%), in 118 of whom the sites of recurrence and metastasis could be identified, 38 in the early-onset young group and 80 in the young adult group. Fifty-five (46.6%) patients developed peritoneal metastases and 40 (33.9%) hematogenous metastases. In the early-onset young group, 20 patients developed peritoneal metastases, 11 hematogenous metastases, five distant lymph node metastases, and two local recurrence. In the young adult group, 35 patients developed peritoneal metastases, 29 hematogenous metastases, six local recurrences, and 10 distant lymph node metastases. The 5-year overall survival and disease-free survival rates were significantly higher in the young adult group than in the early-onset young group (73.7% vs. 57.4%, P=0.002 and 70.6% vs. 55.4%, P=0.004, respectively). Cox multivariate analysis showed that age >32 years (HR=0.63, 95%CI: 0.43-0.90, P=0.012) was an independent protective factor for overall survival, whereas later N stage (HR=1.67, 95%CI:1.09-2.57, P=0.018) was an independent risk factor for overall survival after surgery (P<0.05). Age >32 years (HR=0.60, 95%CI: 0.41-0.86, P=0.006) was also an independent protective factor for disease-free survival, whereas later N stage was an independent risk factor (HR=1.69, 95%CI: 1.08-2.64, P=0.021). Conclusion: Young patients with early-onset gastric cancer aged ≤32 years have worse tumor differentiation and prognosis.

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中华胃肠外科杂志
中华胃肠外科杂志 Medicine-Medicine (all)
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