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目的:通过探讨不同病理类型胃癌的病理特征对临床预后的影响,以期为临床的治疗及预后判断提供指导。方法:对我院2001年1月至2007年7月收集的160例胃癌术后病例进行回顾性病理阅片及分型,并对不同病理类型胃癌淋巴结转移情况及不同病理类型胃癌肿瘤大小与浆膜浸润率、淋巴结转移率进行比较和比较51例不同病理类型胃癌随访患者5a生存率之间的差异,分析不同病理类型胃癌的病理特点及其对临床预后的影响。结果:160例胃癌中,乳头状腺癌9例(占5.63%);管状腺癌35例(占21.88%);低分化腺癌75例(占46.88%);黏液腺癌22例(占13.75%);印戒细胞癌19例(占11.88%)。不同病理类型胃癌淋巴结转移率:多组比较差异有显著性(P<0.05),两两比较印戒细胞癌淋巴结转移率为73.68%,高于乳头状腺癌的11.11%,两者之间差异有显著性(P<0.005),乳头状腺癌与低分化腺癌、黏液腺癌比较差异有显著性(P<0.05),其他两两比较差异无显著性。不同病理类型胃癌肿瘤大小与淋巴结转移率、浆膜浸润率的关系:管状腺癌和低分化腺癌淋巴结转移率,直径>4cm的淋巴结转移率高于直径≤4cm,差异有显著性(P<0.05);低分化腺癌肿瘤直径>4cm的浆膜浸润率高于直径≤4cm,差异有显著性(P<0.05),其他类型比较未见明显差异。随访51例不同病理类型胃癌患者5a生存率:多组比较有明显差异(P<0.05),两两比较,管状腺癌5a生存率为81.82%,乳头状腺癌5a生存率为80%,低分化腺癌为61.54%,三者均高于印戒细胞癌的0%,差异有显著性(P<0.005),其他两两比较差异无显著性。结论:乳头状腺癌属高分化癌,预后较好;管状腺癌和低分化腺癌是胃癌的主要类型,其肿瘤大小与淋巴结转移率呈正相关,与预后呈正相关;低分化腺癌浸润深度与预后呈正相关。5a生存率:乳头状腺癌、管状腺癌和低分化腺癌比印戒细胞癌高;印戒细胞癌属弥漫型(浸润型)胃癌,侵透性强,淋巴结转移率高,5a生存率极低,预后差。
Objective: To explore the clinical pathological features of different pathological types of gastric cancer prognosis, in order to provide guidance for the clinical treatment and prognosis. Methods: A retrospective pathological examination and classification of 160 cases of gastric cancer collected from January 2001 to July 2007 in our hospital were performed. The lymph node metastasis of gastric cancer with different pathological types and tumor size and plasma Membrane invasion rate and lymph node metastasis rate were compared between 51 patients with different pathological types of gastric cancer survival rate of 5a follow-up differences in the analysis of pathological features of different pathological types of gastric cancer and its impact on clinical prognosis. Results: Among the 160 cases of gastric carcinoma, papillary adenocarcinoma was found in 9 cases (5.63%), tubular adenocarcinoma in 35 cases (21.88%), poorly differentiated adenocarcinoma in 75 cases (46.88%), mucinous adenocarcinoma in 22 cases (13.75% %); Signet ring cell carcinoma in 19 cases (11.88%). The lymph node metastasis rates of gastric cancer with different pathological types were significantly different between multiple groups (P <0.05). The lymph node metastasis rate of signet ring cell carcinoma was 73.68%, higher than that of papillary adenocarcinoma (11.11%), the differences between the two (P <0.005). There was a significant difference between papillary adenocarcinoma and poorly differentiated adenocarcinoma and mucinous adenocarcinoma (P <0.05). There was no significant difference between the other two groups. The relationship between tumor size, lymph node metastasis rate and serosal invasion rate of different pathological types of gastric cancer: lymph node metastasis rate of tubular adenocarcinoma and poorly differentiated adenocarcinoma, lymph node metastasis rate> 4cm in diameter was higher than that of diameter ≤4cm, the difference was significant (P < 0.05). The infiltration rate of serosa> 4cm in poorly differentiated adenocarcinoma was significantly higher than that of ≤4cm in diameter (P <0.05), but no significant difference was found in other types. Follow-up of 51 cases of different pathological types of gastric cancer in patients with 5a survival rate: multiple groups were significantly different (P <0.05), pairwise comparison, tubular adenocarcinoma 5a survival rate was 81.82%, papillary adenocarcinoma 5a survival rate was 80% Differentiated adenocarcinoma was 61.54%, three were higher than 0% of signet ring cell carcinoma, the difference was significant (P <0.005), the other two was no significant difference. Conclusions: Papillary adenocarcinoma is well-differentiated and has a good prognosis. Tubular adenocarcinoma and poorly differentiated adenocarcinoma are the major types of gastric cancer. The size of the tumor is positively correlated with the lymph node metastasis and positively correlated with the prognosis. The infiltrative depth of the poorly differentiated adenocarcinoma And the prognosis was positively correlated. 5a survival rate: papillary adenocarcinoma, tubular adenocarcinoma and poorly differentiated adenocarcinoma than signet ring cell carcinoma; signet ring cell carcinoma is a diffuse (infiltrative) gastric cancer, strong permeability, lymph node metastasis rate, 5a survival rate Very low, poor prognosis.