【摘要】：目的:研究比較胃印戒細(xì)胞癌中彌漫浸潤(rùn)型和非彌漫浸潤(rùn)型的臨床病理特征之間存在的差異。方法:收集浙江大學(xué)附屬第一醫(yī)院腫瘤外科2009年1月～2015年12月行胃癌手術(shù)的印戒細(xì)胞胃癌患者共317例,并進(jìn)行回顧性分析,其中彌漫浸潤(rùn)型SRCC73例,占總數(shù)的23.03%,非彌漫浸潤(rùn)型244例,占76.97%。男192例,女125例,男女比例約為1.5:1,年齡16～83歲,中位年齡57歲。對(duì)兩種類型胃印戒細(xì)胞癌的發(fā)病年齡、性別、腫瘤位置、腫瘤大小、TNM分期進(jìn)行統(tǒng)計(jì)分析,并對(duì)有效隨訪的60例印戒細(xì)胞癌患者進(jìn)行了 Kaplan-Meier法生存分析。統(tǒng)計(jì)數(shù)據(jù)主要來(lái)源于手術(shù)記錄以及病理報(bào)告,隨訪數(shù)據(jù)來(lái)自于電話隨訪、門診信息以及臨床影像數(shù)據(jù)庫(kù)。運(yùn)用SPSS軟件對(duì)相關(guān)數(shù)據(jù)進(jìn)行處理和分析。結(jié)果:彌漫浸潤(rùn)型和非彌漫浸潤(rùn)型胃印戒細(xì)胞癌在發(fā)病性別(P=0.830)和年齡(p=0.360)上沒(méi)有統(tǒng)計(jì)學(xué)意義,前者主要侵犯全胃(80.3%),僅有少數(shù)(12.7%)病變局限于遠(yuǎn)端胃,而發(fā)生在近端為和胃體的病例數(shù)更少;非彌漫浸潤(rùn)型的腫瘤最常見(jiàn)的部位為遠(yuǎn)端胃(39.6%)和胃體(34.6%),侵犯全胃的僅占12.5%,另有少數(shù)位于近端胃和賁門(p0.001)。彌漫浸潤(rùn)型SRCC的平均直徑為10.03±3.70(cm),非彌漫浸潤(rùn)型SRCC的腫瘤直徑約為4.40±2.88(cm),兩者相比具有統(tǒng)計(jì)學(xué)意義(p0.001)。所有彌漫浸潤(rùn)型胃印戒細(xì)胞癌中,超過(guò)90%的病例已達(dá)T4期,其中70.8%已侵出漿膜外,20.8%已侵犯鄰近結(jié)構(gòu);在非彌漫浸潤(rùn)的類型中,共有23.7%的胃印戒細(xì)胞癌病變局限于粘膜和粘膜下層,43.2%的病例達(dá)T4a期,11.6%處于T4b期(p0.001)。彌漫浸潤(rùn)型中處于N2期的有18.1%,處于N3期的病例占61.1%;非彌漫浸潤(rùn)型胃印戒細(xì)胞癌中有28.3%的患者未見(jiàn)淋巴結(jié)轉(zhuǎn)移,N2期18.3%,而N3期僅占36.9%(p0.01)。彌漫浸潤(rùn)型中43.1%未累及脈管及神經(jīng),34.7%同時(shí)侵犯了神經(jīng)和脈管;非彌漫浸潤(rùn)型中56.9%累及脈管及神經(jīng),15.1%同時(shí)侵犯了神經(jīng)和脈管(p0.01)。彌漫型SRCC中位生存時(shí)間為19個(gè)月,非彌漫型SRCC中位生存時(shí)間為36個(gè)月;兩者的一年生存率分別為73.3%、76.7%,三年生存率分別為20.0%、46.7%,五年生存率分別為0、36.7%,非彌漫型SRCC的預(yù)后明顯優(yōu)于彌漫型SRCC(P=0.004)。結(jié)論:彌漫浸潤(rùn)型與非彌漫浸潤(rùn)型SRCC在腫瘤發(fā)生部位和腫瘤大小等特征上均有很大差別,并且與非彌漫浸潤(rùn)型的部分早癌相比,彌漫浸潤(rùn)型SRCC多呈現(xiàn)為Ⅲ～I(xiàn)V期胃癌,生存分析的結(jié)果進(jìn)一步證明了非彌漫浸潤(rùn)型SRCC的預(yù)后較彌漫浸潤(rùn)型更好。在彌漫浸潤(rùn)型SRCC中CEA和CA199水平的升高更明顯,或許可以作為疾病診斷以及評(píng)價(jià)預(yù)后的一項(xiàng)輔助指標(biāo),。鑒于兩種胃印戒細(xì)胞癌這種特征的差異,或許是因?yàn)榉肿訉W(xué)水平上的差異才導(dǎo)致了臨床病理學(xué)特征的截然不同。
[Abstract]:Objective: to compare the clinicopathological features of diffuse infiltrating type and non-infiltrating type in signet ring cell carcinoma of stomach. Methods: a total of 317 patients with signet-ring gastric cancer who underwent gastric cancer surgery from January 2009 to December 2015 in the first affiliated Hospital of Zhejiang University were collected and analyzed retrospectively. Among them, diffuse infiltrating type SRCC73 was found in 23.03% of the total. 244 cases (76.97%) were non-diffuse infiltrative type. There were 192 males and 125 females, the ratio of male and female was about 1.5%, the age was 16 to 83 years old, the median age was 57 years old. The age, sex, tumor location, tumor size and TNM stage of two types of signet ring cell carcinoma were analyzed statistically. The survival of 60 patients with signet ring cell carcinoma was analyzed by Kaplan-Meier method. The statistical data mainly came from surgical records and pathological reports. The follow-up data came from telephone follow-up, outpatient information and clinical imaging database. SPSS software is used to process and analyze the related data. Results: there was no significant difference in sex (P < 0. 830) and age (p < 0. 360) between diffuse infiltrating and non-infiltrating signet ring cell carcinoma of stomach. The former mainly invaded the whole stomach (80.3%). Only a few (12.7%) of the lesions were confined to the distal stomach, but fewer cases occurred in the proximal part of the stomach and the body of the stomach. The most common sites of non-invasive tumors were the distal stomach (39.6%) and the gastric body (34.6%). Only 12.5% of the tumors invaded the whole stomach, and a few were located in the proximal stomach and cardia (p0.001). The average diameter of diffuse invasive SRCC was 10.03 鹵3.70 (cm),. The tumor diameter of non-invasive SRCC was about 4.40 鹵2.88 (cm), (p0.001). Of all cases of diffuse infiltrating signet ring cell carcinoma, more than 90% had reached T4 stage, of which 70.8% had invaded the extraserous membrane and 20.8% had invaded the adjacent structure. In all, 23.7% of gastric signet ring cell carcinoma lesions were localized in mucosa and submucosa, 43.2% of the cases reached T4a stage and 11.6% were in T4b stage (p0.001), and 23.7% of gastric signet ring cell carcinoma lesions were located in mucosa and submucosa of gastric signet ring cell carcinoma. In diffuse infiltrative type, 18.1% were in N 2 stage and 61.1% in N 3 stage. In non-invasive signet ring cell carcinoma of the stomach, 28.3% had no lymph node metastasis, 18.3% in stage N2, and 36.9% in stage N3 (p0.01). In diffuse infiltrating type, 43.1% did not involve vessels and nerves, 34.7% invaded nerves and vessels, 56.9% involved vessels and nerves in non-diffuse infiltrating type, 15.1% invaded nerves and vessels at the same time (p0.01). The median survival time of diffuse-type SRCC was 19 months and that of non-diffuse-type SRCC was 36 months. The one-year survival rate was 73.3%, 76.7%, the three-year survival rate was 20.0%, 46.7%, and the five-year survival rate was 0,36.7%, respectively. The prognosis of non-diffuse SRCC was significantly better than that of diffuse SRCC (P = 0.004). Conclusion: there are significant differences in tumor location and tumor size between diffuse invasive type and non-diffuse invasive type of SRCC. Compared with non-diffuse invasive type of partial early cancer, diffuse invasive type of SRCC mostly presents stage 鈪，

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