Clinical Trial Of Lymph Nodes Metastasis Frequency In Young People With Gastric Cancer(Clinical Analysis Of 479 Cases)

Objective: Gastric cancer(GC) is one of the most common gastrointestinal cancer in our country, the morbidity and the death rate of GC has been high. Most patients with GC are diagnosed with advanced GC and overall survival remains poor. GC is generally considered to be an age-related disease and although most of GC patients are≥40 years of age. Although the incidence of advanced GC has steadily decreased because of recent developments in medical screening technology, GC in young people remains a serious problem as routine screening does not include people in young. Lymph node metastasis is a very important factor affecting the prognosis of patients with GC in young. It can help clinicians analysis the number and extent of lymph node metastasis, forecast preoperative staging, guidance the range and extent of lymph node dissection, judge the prognosis by understanding of lymph node metastasis. This article focuses on lymph node metastasis from biological behavior to explore the characteristics lymph node metastasis in GC in young and to enable it to provide evidence-based science basis for clinicians’ standardized treatment.Methods: Collect 479 patients with GC in young who were admitted to the fourth hospital of Hebei medical university from November 1963 to June 2014. This article focuses on lymph node metastasis from gender, tumor location, tumor size, differentiation, macroscopic type, depth of tumor invasion and stage to explore the characteristics lymph node metastasis in GC in young. These data are statistically described and analysed by software SPSS13.0 and P<0.05 indicates the stastistical significance.Results: There are 479 young patients with GC admitted in general surgery department of NO.4 Hospital affilliatted Hebei Medical University from November 1963 to June 2014. Of these, 286(59.71%) were male and 193(40.29%) were female, the median ages were 34.54±5.39 years(range, 14-40 years) for the male and 34.78±4.69 years(range, 16-40 years) for the female. The male-to-female ratios were 1.48:1.Carcinomas were located in the upper third of stomach in 86 patients(17.95%), middle third in 90 patients(18.79%), lower third in 176 patients(36.75%)and two and more parts in 127 patient(26.51%). According to the tumor size, primary tumor>5.0 cm was diagnosed in 248 patients(51.77%), and primary tumor ≤5.0 cm in 231 patients(48.23%). Well and/or moderately differentiated tumor was found in 113 patients(23.59%), and poorly differentiated tumor in 366 patients(76.41%) according to the histology. The BorrmannⅠwas diagnosed in 12 patients(2.89%), Borrmann II in 101 patients(24.33%),Borrmann Ⅲ in 254 patients(61.20%) and Borrmann IV in 48 patients(11.58%), protruded type in 7 patients(10.97%),superficial type in 34 patients(53.12%), depressed type in 23 patients(35.94%) based on macroscopic type. According to the depth of tumor invasion, p T1 cancer was diagnosed in 50 patients(10.44%), p T2 in 46 patients(9.60%),p T3 in 73 patients(15.24%) and p T4 in 310 patients(64.72%), respectively. According to the stage, stage Ⅰ cancer was diagnosed in 64 patients(13.36%), Ⅱ in 109 patients(22.76%),Ⅲ in 233 patients(48.46%) and Ⅳ in 73 patients(15.24%), respectively.1 The total metastasis rate of GC in young is 67.64%.2 The metastasis rate of male in young with GC is 67.13%,and female in young with GC is 68.39% according to the gender.3 The metastasis rate of upper third of stomach is 60.47%,middle third of stomach is 67.78%, lower third of stomach is 65.34%,two parts and more of stomach is 75.59%.4 The metastasis rate of primary tumor ≤ 5.0 cm in diameter is 80.24%,and primary tumor >5.0 cm in diameter is 54.11% according to the tumor size.5 The metastasis rate of Well and/or moderately differentiated tumor is 56.64%,and poorly differentiated tumor is 71.04% according to the histology.6 The metastasis rate of BorrmannⅠis 50%,Borrmann Ⅱ is 64.36%, Borrmann Ⅲ is 82.28%,Borrmann Ⅳ is 79.17%,protruded type is 14.29%,superficial type is 14.71%,depressed type is 26.87% according to the macroscopic type.7 The metastasis rate of p T1 is 22.00%, p T2 is 54.35%, p T3 is 60.27%, p T4 is 78.71%, according to the tumor invasion.8 According to the stage, the metastasis rate of Ⅰis 9.38%, Ⅱ is 31.19%, Ⅲ is 93.56%, Ⅳ is 90.41%, respectively.9 The metastasis is 20.25%, 8.56%, 34.24%, 9.19%, 21.71%, 29.65%, 33. 82%, 20.25%, 5.64%, 3.13%, 4.38%, 6.47%, 2.30%, 2.09%, 1.67%, 2.51% from group 1 to 16.respectively.Conclusions: According to the statistical analysis of 479 cases, we can conclude as follows:1 The total metastasis rate of GC in young is 67.64%.2 The metastasis rate of male in young with GC is 67.13%, and female in young with GC is 68.39% according to the gender.3 The metastasis rate of tumor location is two parts and more of stomach(75.59%), middle third of stomach(67.78%), lower third of stomach(65.34%) and upper third of stomach(60.47%) from high to low.4 The metastasis rate of primary tumor ≤ 5.0 cm in diameter is 80.24%,and primary tumor >5.0 cm in diameter is 54.11% according to the tumor size.5 The metastasis rate of poorly differentiated tumor is 71.04%, higher than well and/or moderately differentiated tumor(56.64%) according to the histology.6 The metastasis rate of protruded type is 14.29%, superficial type is 14.71%, depressed type is 26.87%, there is no statistically significant difference. The metastasis rate of macroscopic type is Borrmann Ⅲ(82.28%), Borrmann Ⅳ(79.17%), BorrmannⅡ(64.36%), Borrmann Ⅰ(50%) from high to low, the difference is statistically significant.7 The metastasis rate of tumor invasion is p T4(78.71%), p T3(60.27%), p T2(54.35%), p T1(22.00%) from high to low. the difference is statistically significant.8 The metastasis rate of stage is Ⅲ(93.56%), Ⅳ(90.41%), Ⅱ(31.19%), Ⅰ(9.38%) from high to low. The difference is statistically significant.9 Group3 has the highest metastasis rate(34.24%), higher than Group7, Group6, Group5, Group1, Group8, Group4, Group2, Group12, Group9,Group11, Group10, Group16, Group13, Group14, Group15.