黏膜内早期胃癌青年患者临床病理特征及内镜下治疗适应证的探讨*

摘要

Objective: To investigate clinicopathological features, risk of lymph node metastasis, and indications of endoscopic submu-cosal dissection (ESD) in young patients with intramucosal early gastric cancer (EGC). Methods: In total, 325 EGC patients who under-went radical gastrectomy and had complete clinicopathological data in Anhui Provincial Hospital from March 2009 to December 2016 were retrospectively evaluated. All patients were confirmed to have intramucosal cancer based on their postoperative pathology re-sults. The patients were assigned into two groups according to their age: young group (≤40 years) and old group (>40 years). The clini-copathological features and safety of ESD in the youth group were analyzed. Results: Among all patients with intramucosal EGC, 30 (9.2%) were in the youth group. Intramucosal cancer in the youth group occurred predominantly in women, and the pathological types were mainly undifferentiated and mixed, which were more likely to metastasize to the lymph nodes. In the youth group, EGC patients with intramucosal differentiated type, who had ESD indications, had no risk of lymph node metastasis. However, the rate of lymph node metastasis was up to 25% in intramucosal undifferentiated-type EGC patients who had expanded ESD indications. Conclusions:Young patients with intramucosal EGC have poor pathological differentiation and strong invasiveness, and ESD may be considered for the treatment of differentiated intramucosal cancer.%目的:探讨青年患者黏膜内早期胃癌临床病理特征、淋巴结转移风险及内镜黏膜下剥离术(endoscopic submucosal dissec?tion,ESD)适应证.方法:回顾性选取2009年3月至2016年12月在安徽省立医院行胃癌根治术、临床病理资料完整的325例早期胃癌患者,所有患者均经术后病理证实为黏膜内癌.根据年龄(≤40岁和>40岁)分为青年组和中老年组,总结青年组临床病理特征和ESD治疗安全性.结果:在所有黏膜内早期胃癌患者中,青年组患者30例(9.2%).与中老年组相比,青年组黏膜内癌多发生于女性,病理类型以未分化型和混合型为主,更容易发生淋巴结转移.符合ESD适应证的分化型黏膜内癌的患者中,青年组淋巴结转移率为0;符合ESD相对适应证的未分化型黏膜内癌的患者中,青年组淋巴结转移率高达25.0%.结论:青年患者黏膜内早期胃癌病理分化程度差,侵袭性更强,分化型黏膜内癌可考虑ESD治疗.