胃小细胞癌41例临床病理特征与预后相关性分析  

The diagnosis, treatment and prognosis evaluation of gastric small cell carcinoma： analysis of 41 cases

作　　者：黄帅[1] 郑朝旭[1] 徐泉[1] 袁兴华[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院腹部外科,100021

出　　处：《中华外科杂志》2013年第3期225-229,共5页Chinese Journal of Surgery

摘　　要：目的探讨胃小细胞癌（SCC）的临床病理特征和影响其预后的因素。方法回顾性分析2000年1月至2012年1月间41例胃SCC患者的临床病理及随访资料。男性35例，女性6例；确诊年龄39～84岁，中位年龄62岁；胃上部病变31例（75．6％），胃中部3例（7．3％），胃下部7例（17．1％）。结果41例胃SCC患者出现不适症状至最终确诊的时间间隔1—13个月，中位时间为3个月；肿瘤最大径2．5—15．0cm，平均6．5em；38例（92．7％）以手术为初始治疗方案，其中25例（61．O％）行根治性肿瘤切除术，13例（31．7％）行姑息性手术，3例（7．3％）仅行化疗。初始的Ⅱ、Ⅲ、Ⅳ期患者分别为2、31和8例。所有患者的中位生存期为19个月，中位无病生存期11个月，1、2、5年生存率分别为70．7％、46．3％和36．6％。患者的总体生存期与肿瘤最大径（x2=5．565）、体重变化（X2=3．688）、手术的根治程度（X2=11．747）以及是否复发（X2=17．966）有关（P〈0．05）。结论胃SCC是胃恶性肿瘤中的罕见病理类型，临床误诊率较高，其病情进展迅速且预后较差，根治性手术切除肿瘤可以显著提高患者的生存期，以手术为主的综合治疗仍是胃SCC的主要治疗手段。Objective To summarize and analyze the clinical feature, therapeutic methods and prognosis of gastric small cell carcinoma （SCC）. Methods The clinical and pathological data of 41 patients diagnosed of gastric SCC were analyzed in this research. Also, the factors which may potentially affect the patients＇ survival outcome were evaluated. There were 35 male and 6 female patients. The age at diagnosis was 39-84 years, median age was 62 years. The 31 cases （75.6%） of gastric SCC patients were involved in the upper third of the stomach, 3 cases （7.3%） in the middle, 7 cases （17.1%） in the lower third. Results The time from the event of symptoms to final confirmation was 1 to 13 months,the median time was 3 months. The longest diameter of tumors was from 2. 5 to 15.0 cm,the average was 6. 5 cm. The 38 cases （92. 7% ） chosed surgery as the first treatment, among which 25 cases （61.0%） were performed radical tumor resection, 13 cases （31.7%） went through palliative resection, and 3 cases （7.3%） just employed chemotherapy. The initial II , III, IV stage were 2, 31 and 8 cases, respectively. The overall median survival time was 19 months, median disease free survival time was 11 months, 1-, 2-, 5-years survival rates were 70. 7%, 46. 3% and 36. 6%, respectively. In univariate survival analysis, the tumor size （ X2 = 5. 565）, change of the body weight （ X2 = 3. 688）, type of operation （ X2 = 11. 747） and relapse or not （ X2 = 17. 966） were obviously correlaed with the prognosis （ P 〈 0. 05 ）. Conclusions Gastric SCC is a rare disease of the gastrointestinal tract, the misdiagnosis rate is high, and the prognosis is dismal. Muti-modality management, with radical surgical resection of the primary lesion followed by standard adjuvant-chemotherapy, affords better local disease control and a better survival outcome.

关 键 词：胃肿瘤 癌 小细胞 病理学 外科 预后 

分 类 号：R735.2[医药卫生—肿瘤]