The Biological Behavior Of Gastric Cancer Of Young People And Clinical Study Of Surgical Treatment

Objective: This article follows a comprehensive analysis of young people aged≤40 years and the incidence of gastric cancer in young people, clinical manifestations, laboratory examinations, clinical biological behavior and surgical treatment, to summarize characteristics of gastric cancer in young people, to regulate the gastric cancerdiagnosis and treatment, to improve the efficacy and long-term survival, and to provide theoretical and clinical objective basis.Methods: 326 cases of young patients with gastric cancer during 1,1996～12,2006 in our hospital were retrospectively analyzed clinical data and select a complete follow-up data of 7016 cases older than 40 years of non-young gastric cancerpatients over the same period as control group, compared the clinical and pathological features of young and non-young gastric cancer patients.Classified records, summary and analysis gender, age, incidence, clinical manifestations, examination methods, tumor biological behavior, treatment, etc of young patients with gastric cancer. Analysis information and data through SPSS 13.0 statistical software, with t test, X~2 test, P <0.05 considered statistically significant.Results:1 the onset of gastric cancer patients young people learn material:1.1 gender distribution: the young people of gastric male 57.4% female 42.6%, men and women make up 1.345:1, compared with the non- youth gastric cancer group, women in the proportion of patients with significantly higher in young people in gastric carcinoma. 1.2 smoking history and alcoholism history: the young people with smoking history of gastric 23.6%; No smoking history 76.4%. With a drinking history occupies 17.5%; No drinking history 82.5%.1.3 blood type and tumor familial history: the young man in family history of gastric cancer of 14.7%; No tumor familial history of 85.3%. Blood type distribution: type A 21.2%; Type B 13.8%; Type O 11.0%; type AB 5.5%; others not check.1.4 complications: young gastric cancer patients with complication 75 cases (23.0%).1.5 incidence:young gastric cancer 4.4%,the number of young gastric cancer came to hospital rose from14 cases to 44 in 11 years, the proportion of gastric cancer incidence rise to 4.9% by 3.3%.2 clinical manifestations2.1 symptoms: the young man in epigastric discomfort and abdominal pain60.7%,gastric full after eating of colonoscopy24.2%, gastrointestinal hemorrhage 19.3%, eating and choking feeling rather 15.9%, nausea, vomiting, the acid 15.9%, other accounts for gas, angular, weight loss 15.6% of 8.3%.2.2 signs: the young man in the stomach of abdominal tenderness of 12.9%, anemia 28.8%, abdominal touch bag piece11.0%, ascites8.0%, left supraclavicular lymph nodes positive 5.2%, anus of 0.9%, without positive signs 53.4%.2.3 preoperative complications: the young man in the stomach bleeding 6.7%, the obstruction 4.6%, perforation of 1.2%.3 auxiliary examination3.1 gastroscope, imaging examination Gastroscope inspection adds histologic bite inspection, diagnosis rate 98.4%; upper gastrointestinal series diagnosisrate 81.7%; CT examination positive signs detection84.2%, B-ultrasonic examination positive signs 44.9%. So, gastroscope inspection pathological diagnosis and bite in the highest, and CT examinate around, adjacent organs and stomach diagnosis of distance metastases, is better than B ultrasonic.3.2 misdiagnosed rateYoung doctor gastric this first misdiagnosis rate is 4.0%.4 young men stomach cancer pathological features4.1 tumor location:From 1996 to 2006, the tumor location of young people take surgery operation in our hospital: gastric upper comprising 20.8%;the central stomach 24.4%; The lower stomach 53.0%; full stomach accounted for by 1.8%. Compared with the non-young man gastric cancer, youth stomach cancer in the position of lower stomach. Young people make statistical graphic about during the 11 years gastric cancer location, obvious changes in the trend.was not found.4.2 tumor size: the young man in the stomach cancer patients with tumor size < 5cm occupy 22.3%;≥5cm occupy 77.7%. Young gastric carcinoma patients with tumor size≥5cm is more compared with non-youth.4.3 general shape classification:Early stomach accounted for 8.8 %. Early stomach general shape classificationⅠtype for3 cases:Ⅱtype 16 cases,Ⅲtype 6 cases. This young man patients with typeⅡgastric see more . Adanced gastric cancer accounts for 91.2% .Adanced gastric cancer tumors generally shape classification: BorrmannⅠparting of 3.8%, BorrmannⅡtype of 19.8%, BorrmannⅢtype of 42.2%, and BorrmannⅣtype of 31.4% .BorrmannⅤtype of 2.3%. Visible, this young man inⅢBorrmann gastric type more see. 4.4 histologic classification:Differentiation degree: young stomach group well-differentiated including middle- high differentiated adenocarcinoma patients accounted for 29.3%; poorly differentiated including anaplastic carcinoma, seal ring cell carcinoma, low differentiated adenocarcinoma of other of patients 70.7 %. Compared with the non-young people gastric cancer, the young people of gastric cancer differentiation degree is poorly.4.5 tumor infiltration depth: T1 accounted for 8.8%: T2 accounted for 7.0%; T3 accounted for 14.5%; T4 accounted for 69.7%. Tumor invasion depth comparison between youth stomach cancer patients and the non-youth of tumor, tumor invasion serosal layer more in the middle-aged group4.6 lymph node metastasis: lymph node number up to 32 untrimmed ovoid, average gather 9.4 + 3.7 medal. In young radical excision 249 cases of gastric cancer, including lymph node metastasis of 25.0% for N0, N1 for 17.7%; N2 accounted for 35.6%; N3 for 15.6 %.4.7 distant metastases: M0: accounted for 91.5%; M1: accounted for 8.5 percent. Compared with the non-youth gastric cancer, youth gastric cancer group is more to occur distant metastases.4.8 pTNM stages:Ⅰperiod of 7.4%;Ⅱperiod of 12.7%; forⅢperiod of 71.4%;Ⅳperiod of 8.5%. Compared with non-young people group, young gastric cancer group see more toⅢ-Ⅳperiod5 surgical treatmentsYouth gastric cancer of surgery patients have 283 case, accounts for 86.8%, no- surgery patients have 43 cases, accounting for 13.2%.5.1 surgery properties: palliation excision of 87.9%, radical excision of 6.4%, turn flow of 0.8%, pure surgical exploration of 4.9%.5.2 with the scope: Youth gastric cancer of surgery patients has 267 cases ,which include surgical of radical excision and palliation excision. The proximal stomach to excise of 22.1%,and distal stomach to excise of 46.1%, all the stomach to excise of 31.8%. The combined multi-visceral resection of 10.8%, 89.2% no multi-visceral resection accounted for 89.2%. Compared with non-young people , the young people in gastric multi-visceral resection is more higher.5.3 gastrointestinal reconstruction ways: Yonth gastic cancers of gastrointestinal revascularization have 267 case, which include surgical of radical excision and palliation excision. BishopⅠanastomosis 30.3% bishopⅡanastomosis of 15,7%, beach of residual stomach esophagus anastomosis of 20.2%, esophageal jejunum anastomosis of 25.8% , others accounted for 7.9%.5.4 postoperative complications including 29 cases, 4 cases have complications after multi-visceral resectio, and 25 patients have complications did not do multi-visceral resection. Youth stomach group in the postoperative complications, no change between combined multi-visceral resection and non-combined multi-visceral resection.Conclusion:(1) Gender: female ratio of patients with gastric cancer was significantly higher in young women; the incidence is nearly equal to male, male to female ratio of 1.345:1(2) incidence: 1996 -2006 young patients with gastric cancer during the same period each year,showing that the incidence of gastric cancer of young people every year.(3) Clinical manifestations: Clinical manifestations poor specificity, no positive signs is more, which shows that poor specificity in young gastric tumor patients.(4) auxiliary examination:young people in the endoscopic diagnosis of gastric cancer and the detection rate of pathological bite seized 98.4%, higher than 81.7% of upper digestive tract angiography in the diagnosis, CT can prompt positive signs. (5) tumor location: young people in gastric tumor patients, 53.0% lower stomach most common, followed by central stomach, proximal gastric,full stomach. The lower stomach is more common in yonth gastric cancer patients. Young people make statistical graphic about during the 11 years gastric cancer location, obvious changes in the trend.was not found.(6) tumor size and histologic classification: young gastric carcinoma patients with tumor size≥5cm is more(77.7%). histologic classification is poorly differentiated(70.7%).(7) staging and general form: 8.8% of young people as early cancer, the progress of young people in the period of the Borrmann type,Ⅲtype accounted for 42.2% in most, followed by typeⅣ,Ⅱ,Ⅰ,Ⅴtype.(8) the depth of invasion: young stomach cancer patients infiltrating depth of T4 of most, followed by T3, T2 and T1. T3 were significantly different in both groups, youth groups more common.(9) TNM staging: stageⅢgastric cancer of young people accounted for 71.4% of the most common, followed byⅡ,Ⅳ, andⅠ.Compared with the control group, youth group stageⅢ-Ⅳgastric cancer more common.(10) Surgical treatment: young patients who take surgical 86.8% of patients, among them,radical resection in 87.9%,resecting lower stomach were the most (46.1%),secondly total gastrectomy, and proximal stomach; Compared with multi-visceral resection,young patients have more resecte rate than non-youth group.Digestive tract reconstruction after tumor resection in order to bishopⅠanastomosis (30.3%)match common, followed by esophageal jejunostomy, gastric remnant esophagusconsistent, bishopⅡanastomosis, jejunal inter- position operation.postoperative complications including 29 cases, no change between combined multi-visceral resection and non-combined multi-visceral resection.