| Objective:To compare the clinical features between young and middle-aged and elderly patients with advanced gastric cancer in Chaoyang city and to analyze the factors affecting the prognostic,providing theoretical reference for the prognostic evaluation of advanced gastric cancer.Methods:From March 2006 to March 2011,321 patients who were diagnosed with advanced gastric cancer in the central hospital of chaoyang city were studied,clinical follow-up study was performed,the follow-up visit ended until March 31,2016.Some features were recorded including patients' name,gender,age,course of diseases on admission,clinical manifestation,location,degree of differentiation,pathological type,operation method,TNM stage,infiltration depth,lymph node metastasis and carcinoembryonic antigen(CEA)concentration,postoperative chemotherapy,smoking index,family history of gastric cancer,living condition etc.According to age,more than 20 years old and below 60 years old were set to the middle and youth group(125 cases),60 years old or over 60 years old were set to the elder group(196).The clinical features of the advanced gastric cancer were compared and analyzed between two groups to explore factors that affect the prognosis.SPSS20.0 was used for statistical analysis.Results:1.There were no statistical significance between two groups in gender distribution,depth of infiltration,pathological type,concentration of CEA,distant metastases,family history of gastric cancer,surgical procedure and postoperative chemotherapy(P > 0.05).2.The rate of smoking index(?400)in middle and youth group was 36.8%,lower than that of the elder group(53.57%,P < 0.05).3.The rate of illness duration < 3 months in the middle and youth group was 48.80%,more than that of the elder group(19.39%,P < 0.05);The rate of illness duration in 3-6 months in the middle and youth group was 26.40%,less than that of the elder group(48.98%,P < 0.05);There was no statistical significance between two groups in duration over 6 months(P > 0.05).4.The rate of low-differentiated cancer in the middle and youth group was 48.80 %,higher than that of elder group(36.22 %,P < 0.05);The rate of middle and high differentiated cancer was 51.20%,lower than that of elder group(63.77%,P < 0.05).5.The rate of lesion in the gastric body in the middle and youth group was 52.00%,higher than that of elder group(36.22%,P < 0.05);The rate of lesion in the sinuses ventriculi in the middle and youth group was 37.60%,less than that of elder group(52.55%,P < 0.05);There were no statistical significance between two groups in lesion of cardia,fundus and angle of stomach(P > 0.05).6.The rate of TNM-? stage patient in middle and youth group was 49.60%,higher than that of elder group(14.80%,P < 0.05);The rate of TNM-?,? stage patient in middle and youth group were 12.80% and 25.60% respectively,less than those of elder group(37.24%,38.27%,P < 0.05).There were no statistical significance between two groups in TNM-? stage(P > 0.05).7.The rate of lymph node metastases in the middle and youth group was 75.2%,higher than that of the elder group(46.94%,P < 0.05).8.There were no statistical significance between two groups in clinical manifestations such as abdominal mass,abdominal distension,difficulty swallowing,weight loss,nausea or vomiting,black or hematemesis,abdominal pain,anemia(P > 0.05).9.The 1-year,3-year,5-year survival rate of the middle and youth group were 75.65%,45.21 %,26.40 % respectively;The 1-year,3-year,5-year survival rate of the elder group were 84.83%,61.79 %,35.39 % respectively,there were statistically significant between two groups(P < 0.05).10.Case completion: Until the March 31,2016,a total of 302 cases were followed up,follow-up visit rate 94.08%(302/321).In the 19 patients who were excluded,5 cases(4 of middle and youth group,1 of elder group)were operated again for gastric cancer,5 cases(1 of middle and youth group,4 of the elder group)were bad compliance,3 cases(2 of middle and youth group,1 of the elder group)dropped out of the study,3 cases(1 of middle and youth group,2 of the elder group)were committed to suicide,2 cases(1 of middle and youth group,1 of the elder group)died from accident,1 of the middle and youth group lost contact.The screening of prognostic factors in middle and youth advanced gastric cancer : the log-rank test showed that,Gender,lymph node metastasis,distant metastasis,differentiation,TNM stage,surgical methods,chemotherapy were the suspicious factors(P < 0.05),however,the duration of the disease,the depth of infiltration,the CEA concentration,and the smoking index were not the factors affecting the prognosis of gastric cancer(P > 0.05).Multifactor Cox model analysis found: lymph node metastasis(B=0.558,HR=1.765),distant metastasis(B=0.614,HR=2.835),differentiation degree(B=0.597,HR=1.957),TNM stage(B=0.584,HR=1.557),way of operation(B=0.677,HR=1.009),chemotherapy(B=0.537,HR=1.587)were independent factors affecting the prognosis of middle and youth patients(P < 0.05).The screening of prognostic factors in the elder advanced gastric cancer: the log-rank test showed that the depth of infiltration,lymph node metastases,distant metastases,the degree of differentiation,and the surgical approach are the suspect factors(P < 0.05),however,gender,pathogenesis,CEA concentration,smoking index,TNM stage and chemotherapy were not the factors affecting the prognosis(P >0.05).Multifactor Cox model analysis found: lymph node metastases(B=2.245,HR=9.437),distant metastases(B=0.1.391HR=4.018),surgical methods(B=0.489,HR=1.630),and depth of infiltration(B=0.0.821,HR=2.440)are independent factors affecting the prognosis of elder advanced gastric cancer(P < 0.05).Conclusion:1.The advanced gastric cancer in middle and young age of Chaoyang city is common seen in men,low differentiation adenocarcinoma is more,more are found in the sinuses ventriculi and stomach body,having the short course,strong invasion ability,the low differentiation,poor prognosis,having no specific clinical manifestations.Lymph node metastasis,distant metastasis,differentiation degree,TNM stage,way of operation,chemotherapy were independent factors affecting the prognosis of middle and young patients.2.The advanced gastric cancer in elder group of Chaoyang city is common seen in men,high differentiation adenocarcinoma is more,more are found in the sinuses ventriculi and stomach body,having the long course,weak invasion ability,the high differentiation,better prognosis,having no specific clinical manifestations.Lymph node metastasis,distant metastasis,way of operation,depth of infiltration were independent factors affecting the prognosis of elderly patients.3.Advance gastric cancer has no specific clinical manifestations,person with unexplained upper abdominal distension,abdominal pain,and anemia should be aware of the possibility of gastric cancer,do stomachscopy as soon as possible;The middle and young people should pay more attention to avoid delays. |
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