年轻女性胃腺癌患者术后临床病理特征及预后影响因素

姜文超; 孙祥飞; 熊冉; 高晓东

doi:10.12025/j.issn.1008-6358.2025.20250971

年轻女性胃腺癌患者术后临床病理特征及预后影响因素

Analysis of clinicopathological features and prognostic factors in young female patients with gastric adenocarcinoma

摘要

摘要:
目的分析年轻女性胃腺癌患者的临床病理特征和生存预后情况。
方法回顾性收集2014年1月至2020年12月在复旦大学附属中山医院接受根治性胃切除术、术后病理诊断为胃腺癌的女性患者资料。将年龄≤45岁者定义为年轻组（n＝287），根据pTNM分期按1∶2匹配同期确诊的≥60岁女性患者（老年组，n＝574），比较两组患者的临床病理特征差异。绘制Kaplan-Meier曲线，采用log-rank检验比较总生存（overall survival, OS）率，Cox回归模型分析年轻女性患者预后的影响因素。
结果与老年组相比，年轻女性胃腺癌患者的肿瘤发生部位多为胃中部，胃上部发生率较低；肿瘤分子分型多表现为HER2低表达、Ki-67高表达；病理分类及类型多为低分化或未分化腺癌、印戒细胞癌；Lauren分型以弥漫型为主，肠型占比较低（P＜0.05）。分层分析显示，对于Ⅱ期和Ⅲ期患者，两组OS率差异无统计学意义；而在Ⅰ期患者中，年轻组OS率显著高于老年组（P＝0.037）。多因素Cox分析和log-rank检验结果证实，pN₃期（HR＝3.576，95%CI 1.652～7.740）、Ⅲ期（HR＝3.581，95%CI 1.059～12.106）及Lauren弥漫型（HR＝2.711，95%CI 1.316～5.585）为年轻女性胃腺癌患者预后不良的相关因素。
结论年轻女性胃腺癌患者临床病理特征以弥漫型、低分化、高增殖为主要特点，pN₃期、Ⅲ期及弥漫型胃腺癌与该患者群体的不良预后相关。

Abstract:
Objective To analyze the clinicopathological characteristics and survival prognosis of young female patients with gastric adenocarcinoma.
Methods A retrospective analysis was conducted on female patients who underwent radical gastrectomy at Zhongshan Hospital, Fudan University between January 2014 and December 2020, with postoperative pathological confirmation of gastric adenocarcinoma. Those aged ≤45 years were defined as the young group (n＝287), and were matched in a 1∶2 ratio by pTNM stage with female patients aged ≥60 years (elderly group, n＝574). Clinicopathological characteristics were compared between the two groups. Survival curves were plotted using the Kaplan-Meier method, and overall survival (OS) rates were assessed by log-rank test. Prognostic factors in the young group were analyzed using Cox regression models.
Results Compared to elderly patients, young female gastric cancer patients exhibited a higher prevalence of tumors in the middle third of the stomach and a lower proportion in the upper third of the stomach. Molecular profiling revealed a higher frequency of HER2-low expression and elevated Ki-67 index. Pathologically, these patients were more frequently diagnosed with poorly differentiated or undifferentiated adenocarcinoma and signet ring cell carcinoma, while Lauren classification showed a predominance of the diffuse type with a lower proportion of the intestinal type (P＜0.05). Stratified analysis showed no significant difference in OS rates between the two groups for stage Ⅱ and Ⅲ patients; however, among stage Ⅰ patients, the young group had significantly better OS rates than the elderly group (P＝0.037). Multivariate Cox analysis and log-rank test confirmed that pN₃ stage (HR＝3.576, 95%CI 1.652–7.740), stage Ⅲ (HR＝3.581, 95%CI 1.059–12.106), and diffuse type (HR＝2.711, 95%CI 1.316–5.585) were risk factors for poor prognosis in young female gastric cancer patients.
Conclusions Young female patients with gastric adenocarcinoma typically present with clinicopathological features such as the diffuse type, poor differentiation, and high proliferation. Moreover, pN₃ stage, stage Ⅲ cancer, and the diffuse type histology are correlated with a poor prognosis in this demographic.

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