The Clinical Analysis Of Gastroscope Appearance For Advanced Gastric Carcinoma

Gastric cancer is one of the most common gastrointestinal system malignant tumors, There is a higher incidence than other various tumors in our country,and the rate of early diagnosis is low, the majority have entered a period of progress when they were found. According to Borrmann classification, advanced gastric cancer is divided into polypoid (BorrmannⅠtype), ulcer type (BorrmannⅡtype), ulcer infiltration type (BorrmannⅢtype), and extensive infiltration type (BorrmannⅣtype). The prognosis of advanced gastric cancer is poor,the 5-year survival rate is low. To study the relevance between the biological behaviors and the clinical features of gastric cancer, this paper collected the information of 350 patients,who were hospitalized in our hospital from January 2004 to December 2008 and diagnosed advanced gastric cancer by postoperative pathology,excluding the patients whose general information and postoperative pathology were incomplete. To understand the relationship between the gender, age, occupation,smoking(yes or no) , drinking (yes or no), first symptom, time of disease history,location,depth of invasion, lymph node metastasis, distant metastasis, clinical stage, pathological type and four kinds of Borrmann types, we collected the above-mentioned factors respectively from 350 cases with advanced gastric cancer,and the SAS 8.0 software was used to analysis them with chi-square test.The results obtained are as follows:1. EpidemiologyIn the 350 cases of advanced gastric cancer patients,the number of male was 268 cases, and female was 82 cases.The ratio of male and female was 3.27:1,and the men accounted for 76.57%. Four kinds of Borrmann types were no differences between male and female (χ2 = 1.16, P> 0.05),and BorrmannⅡtype andⅢtype were also no differences between sexes(P> 0.05).The age of onset was from 32 to 85 years old, and the average age was 40.5 years old. There were 95 cases between 30 to 50 years old, and 202 cases between 50 to 70 years old,and 53 cases were older than 70 years old. The patients between 50 to 70 years old had higher incidence than other age groups, accounting for 57.71%.The cases withⅠtype toⅢtype between 50 to 70 years old were more than other age groups, and the proportion of them were 68.75%, 56.68%, 65.72% respectively, butⅣtype between 30 to 50 years old were more than other age groups, accounting for 66.66%. Four kinds of Borrmann types were no differences among different age groups(χ2 = 7.33, P> 0.05),and BorrmannⅡtype andⅢtype were also no differences among them(P> 0.05). There were 155 cases of farmers, cadres of 83 cases, 112 cases of works.The number of farmers was more than others, accounting for 44.29%.Borrmann types were no differences among occupations(χ2 = 1.31, P> 0.05). BorrmannⅡtype andⅢtype were also no the occupational differences (P> 0.05). In the 350 cases,there were 73 cases to smoke,and 64 cases to drink. Comparing Borrmann types with smoking and drinking respectively, there were no differences (χ2 = 1.15, P> 0.05;χ2 = 4.79, P> 0.05),and BorrmannⅡtype andⅢtype were also not different (all P> 0.05).2. Time of disease history and first symptomsThe time of disease history were from 15 days to 5 years differently, and the average time of disease history was 13.5 months.The time of disease history of 273 cases were less than 6 months,and the time had exceeded 6 months with 77 cases.The time of Borrmann types cases were mostly less than 6 months,and the time of BorrmannⅠtype cases were shortest than other types, accounting for 93.8%.In the time of disease history, four sub-types of Borrmann didn't exist differences (χ2 = 7.31, P> 0.05). BorrmannⅡtype andⅢtype were also no differences (P> 0.05).In 350 cases, patients of the first symptom as abdominal pain were 247 cases, abdominal distention were 58 cases, hematemesis and melena were 24 cases, others were 21 cases.Abdominal pain was the most common first symptom, accounting for 70.57%. Four types of Borramann were all most than other first symptoms. Comparing the relevance between Borrmann types and the first symptoms,four sub-types of Borrmann didn't exist differences (χ2 = 8.11, P> 0.05). BorrmannⅡtype andⅢtype were also no differences (P> 0.05).3. LocationIn this group,tumors located in the cardia and fundus were 18 cases, gastric body and gastric angle were 123 cases, antrum were 149 cases, the whole stomach were 60 cases.The number of cases located in antrum was more than other situs, accounting for 42.57%.From BorrmannⅠtype toⅢtype, antrum was the most common locus,but BorrmannⅣtype mostly involved the entire stomach. The constituent ratio of Borrmann types had a significant difference in situs(χ2 = 32.17, P <0.01), BorrmannⅡtype andⅢtype in the cardia, fundus and antrum had no differences (P> 0.05), but in the gastric body, gastric angle and wide stomach exsisted differences.The incidence of BorrmannⅡtype in the gastric body and gastric angle were higher than BorrmannⅢtype(P <0.05), but BorrmannⅢtype in the whole stomach was higher than BorrmannⅡtype(P <0.01) , suggesting that BorrmannⅢtype more easily involved the whole stomach than BorrmannⅡtype.4. Depth of invasionThere were 230 cases for T2 , 44 cases for T3, 76 cases for T4. In BorrmannⅠtype,Ⅱtype andⅢtype,T2 was most than other depths of invasion.BorrmannⅣtype invased T4 commonly.The constituent ratio of Borrmann types with infiltration depth were different (χ2 = 12.65, P <0.05), and BorrmannⅡtype andⅢtype had differences in T2 and T4.Comparing BorrmannⅡtype withⅢtype,Ⅱtype more frenquently infiltrated with T2 (P <0.01), BorrmannⅡtype more easily invased T4 (P <0.05).5. Lymph node metastasisIn 350 patients, 227 cases had lymph node metastasis, and the rest of 123 cases didn't exsist lymph node metastasis. In Borrmann types, the lymph node metastasis rate ofⅢtype was the highest than other types,but the incidence ofⅠtype was the lowest.The constituent ratio of four kinds of Borrmann sub-types for lymph node metastasis was markedly different (χ2 = 11.97, P <0.01). Comparing BorrmannⅡtype withⅢtype,Ⅲtype was more susceptible to occur lymph node metastasis, there was a obvious statistical significance (P <0.01 ).6. Distant metastasisIn this paper, 82 cases happened distant metastasis,and liver was a key location for distant metastasis, accounting for 43.90%. In all types of Borrmann, the highest rate of occurrence of distant metastasis wasⅣtype.In distant metastasis among the four Borrmann types,there was a significant difference(χ2 = 16.15,P <0.01).BorrmannⅢtype was more susceptible to occur distant metastasis thanⅡtype, there was a significant statistical difference (P < 0.01).7. Clinical stageIn 350 cases, clinicalⅠstage was 116 cases,Ⅱstage was 97 cases,Ⅲstage was46 cases,Ⅳstage was 91 cases. BorrmannⅠtype andⅡ-type commonly were staged intoⅠphase,but BorrmannⅢtype andⅣtype were found in stageⅣregularly. Comparing the stage and Borrmann types,four kinds of sub-types had a significant difference in the ratio of composition (χ2 = 11.97, P <0.01).The clinicalⅠperiod of BorrmannⅡtype more thanⅢtype, but the clinicalⅣperiod less thanⅢtype,there were instinct statistical significance(all P <0.01).8. Pathological typeIn this group,the patients of poorly differentiated adenocarcinoma were 247 cases, the signet-ring cell carcinoma were 74 cases,other types were 29 cases. Comparing the four kinds of sub-types of Borrmann,the ratio of component exsisted differences among pathological types(χ2 = 14.86, P <0.05),the incidence of poorly differentiated adenocarcinoma for BorrmannⅡtype higher than typeⅢ,while the incidence of signet-ring cell carcinoma lower than typeⅢ,the difference had statistical significance (all P <0.05). In addition,the number of BorrmannⅣtype in this article was all lower than other papers reported at home and abroad,only accounting for 1.72%.The cases whose information were incomplete didn't been selected into the group,which was considered as a impotant reason for it.All in all,four kinds sub-types of Borrmann for advanced gastric cancer had diffenrences in clinical characteristics,and BorrmannⅡtype andⅢtype exsisted differences among situs,depth of invasion,lymph node metastasis,distant metastasis,clinical stage,pathological type.The results suggested that various Borrmann types of gastric cancer may be have different mechanism in the course of occurreunce,development, metastasis, and they also proverd that Borrmann typing can be used as an important prognostic indicator for advanced gastric cancer and had great significance of guidance for clinical work.