Extreme Aggressiveness and Lethality of Gastric Adenocarcinoma in the Very Young
Extreme Aggressiveness and Lethality of Gastric Adenocarcinoma in the Very Young
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DOI：
10.1001/archsurg.2009.77
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发表时间：
2009-06-01
影响因子：
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通讯作者：
Stabile, Bruce E.
中科院分区：
文献类型：
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作者：
Smith, Brian R.;Stabile, Bruce E.
目的：确定非常年轻的胃腺癌患者与老年患者相比，是否具有生物学上更具侵袭性的疾病形式，出现在晚期，并赋予异常差的围手术期和长期预后。设计、环境和患者：对350例诊断为胃腺癌的患者进行为期15年、单机构、回顾性回顾和人口统计学和结局数据分析。主要观察指标：非常年轻和老年患者组的组织学特征、IV期疾病频率、治愈性胃切除术频率、术后死亡率和长期生存率。结果：在350例患者中，30例（9%）年龄在35岁或以下。非常年轻的患者（35岁）更常有弥漫性肿瘤组织学表现（分别为93%对69%，P= 0.003）、邻近器官侵犯（分别为74%对29%，P= 0.001）、淋巴结转移（分别为94%对70%，P= 0.046）、远处转移（分别为81%对50%，P= 0.003）和IV期疾病（分别为90%对64%，P= 0.003）。有治愈潜力的胃切除术在58%的老年患者中完成，但在非常年轻的患者中只有17% （P=.001）。只有6%的老年患者进行了非治疗性手术，但33%的非常年轻的患者进行了非治疗性手术（P= 0.002）。与老年患者相比，非常年轻的患者与晚期疾病相关的术后死亡率较高（分别为22%对2%；P= 0.003）。老年患者的平均生存期为33.4个月，而非常年轻的患者仅为11.6个月（P= 0.02）。结论：非常年轻的患者(年龄
Objective: To determine whether very young patients with gastric adenocarcinoma as compared with older patients with the disease have a biologically more aggressive form of the disease, presenting at an advanced stage and conferring unusually poor perioperative and long-term outcomes.Design, Setting, and Patients: A 15-year, single-institution, retrospective review and analysis of demographic and outcomes data for 350 patients diagnosed with gastric adenocarcinoma.Main Outcome Measures: Histologic features, frequency of stage IV disease, frequency of curative gastric resection, postoperative mortality, and long-term survival in very young and older patient groups.Results: Of 350 total patients, 30 (9%) were aged 35 years or younger. Very young patients (aged 35 years) more often had diffuse-type tumor histologic findings (93% vs 69%, respectively; P=.003), adjacent organ invasion (74% vs 29%, respectively; P=.001), nodal metastases (94% vs 70%, respectively; P=.046), distant metastases (81% vs 50%, respectively; P=.003), and stage IV disease (90% vs 64%, respectively; P=.007). Potentially curative gastrectomy was accomplished in 58% of older patients but only 17% of very young patients (P=.001). Nontherapeutic operations were performed in only 6% of older patients but 33% of very young patients (P=.002). Very young patients as compared with older patients had high postoperative mortality (22% vs 2%, respectively; P=.003) related to advanced- stage disease. Mean survival was 33.4 months among older patients compared with only 11.6 months for very young patients (P=.02).Conclusions: Very young patients (aged