14例早发性胃癌患者的临床及病理特征分析

Clinicopathological Characteristics of Early-Onset Gastric Cancer: An Analysis of 14 Cases

摘要: 目的：探讨早发性胃癌患者的临床及病理特征。方法：对2023年6月至2026年6月期间在宿州市第一人民医院经组织病理学诊断为胃癌的157名患者进行了回顾性调查研究，并在其中以1:2的比例随机选择同期晚发性胃癌患者作为对照。通过电子病历系统收集患者的临床信息，包括性别、年龄、主要症状、相关风险因素(家族史、吸烟、饮酒、肥胖)和内镜检查情况，通过病理诊断系统收集患者的幽门螺旋杆菌感染情况与肿瘤的病理学诊断结果，对早发性胃癌患者的临床及病理特征进行分析与归纳。统计学比较采用卡方检验和Fisher精确检验。结果：在157例胃癌患者中，14例为早发性胃癌患者(8.9%)，平均发病年龄43.6岁，男性患者占比71.4% (n = 10)，女性患者占比28.6% (n = 4)；患者以腹部不适症状常见，吸烟、饮酒比例较晚发性胃癌低；内镜检查中，早发性胃癌更常表现为溃疡性病变，差异具有统计学意义(χ² = 3.938, P = 0.047)；低分化肿瘤与印戒细胞癌在早发性胃癌中占比更高，差异具有统计学意义(χ² = 5.774, P = 0.016)；晚发性胃癌患者的幽门螺旋杆菌感染比例更高，而在早发性胃癌当中幽门螺旋杆菌感染的患者更多表现为低分化肿瘤和印戒细胞癌，但差异不具有统计学意义(P > 0.05)。结论：这项研究表明早发性胃癌可能多发于男性患者，但女性的平均发病年龄较男性有所提前，患者就医时多有腹部不适症状，吸烟、饮酒、肥胖、家族史等风险因素在早发性胃癌中的影响程度或许有限，早发性胃癌更倾向于表现为胃内的溃疡性病变；同时本研究强调了早发性胃癌多具有分化不良的病理学特征；而幽门螺旋杆菌的感染则与更可能具侵袭性的肿瘤生物学特征相关联。鉴于其患者年轻化和发病率逐年上升的特点，加强危险因素管理、优化人群筛查方法、寻找新的治疗方案至关重要。

Abstract: Objective: To investigate the clinicopathological characteristics of patients with early‑onset gastric cancer. Methods: A retrospective study was conducted on 157 patients histopathologically diagnosed with gastric cancer at Suzhou First People’s Hospital from June 2023 to June 2026. Among them, patients with late‑onset gastric cancer during the same period were randomly selected as controls at a 1:2 ratio. Clinical data, including sex, age, main symptoms, relevant risk factors (family history, smoking, alcohol consumption, obesity), and endoscopic findings, were collected from the electronic medical record system. Helicobacter pylori infection status and pathological tumor diagnoses were obtained from the pathology database. The clinical and pathological features of early‑onset gastric cancer were analyzed and summarized. Statistical comparisons were performed using the chi‑square test and Fisher’s precision probability test. Results: Among the 157 gastric cancer patients, 14 (8.9%) were identified as early‑onset cases, with a mean age of onset of 43.6 years. Male patients accounted for 71.4% (n = 10) and female patients for 28.6% (n = 4). Abdominal discomfort was the most common presenting symptom. The proportions of smokers and drinkers were lower than those in the late‑onset group. On endoscopy, early‑onset gastric cancer more frequently presented with ulcerative lesions, and the difference was statistically significant (χ² = 3.938, P = 0.047). Poorly differentiated tumors and signet ring cell carcinoma were more prevalent in early‑onset gastric cancer, with statistically significant differences (χ² = 5.774, P = 0.016). The proportion of H. pylori infection was higher in late‑onset patients; however, in early‑onset patients, H. pylori infection was closely associated with poorly differentiated tumors and signet ring cell carcinoma, and this association was not statistically significant (P > 0.05). Conclusion: This study suggests that early‑onset gastric cancer may be more common in male patients, but the mean age of onset in females was earlier than that in males. Patients commonly presented with abdominal discomfort at initial consultation. The influence of risk factors such as smoking, alcohol consumption, obesity, and family history may be limited in early‑onset gastric cancer. Early‑onset tumors tend to manifest as ulcerative gastric lesions. Furthermore, this study highlights that early‑onset gastric cancer is frequently characterized by poorly differentiated pathology, and H. pylori infection is associated with more aggressive tumor biological features. Given the younger age of onset and the rising annual incidence, it is crucial to strengthen risk factor management, optimize population‑based screening strategies, and explore novel therapeutic approaches.