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目的:青少年胃癌发病罕见，目前国内外关于青少年胃癌研究局限于少量病例报道，缺乏其临床病理特征大样本数据分析。本文探讨10~24岁青少年胃癌的临床病理特征及影响其预后的相关因素。方法:本研究采用病例对照研究方法。回顾性收集2000年2月至2017年2月期间在北京解放军总manbet官网登录 第一医学中心就诊的10~24岁青少年胃癌患者的临床病理资料，并按照1∶2比例、通过电脑数字表法随机选取同期收治的40岁以上胃癌患者的临床病理资料，比较青少年胃癌患者和>40岁胃癌患者的一般临床资料、病理资料和治疗措施。对青少年胃癌患者进行随访，记录其总体生存情况。应用Cox比例风险模型分析影响青少年胃癌患者预后的因素。结果:2000年2月至2017年2月期间，收治胃癌患者14 794例，青少年胃癌患者63例（0.4%），其中男性31例（49.2%），女性32例（50.8%）；体质指数（19.5±4.3）kg/m 2。青少年胃癌患者确诊前仅35例（55.6%）有警示性症状，包括体质量减轻、腹水、梗阻、呕血、黑粪等；存在消化道肿瘤家族史者5例（7.9%）。确诊前症状持续中位时间为3个月，确诊时肿瘤为低分化者58例（92.1%），肿瘤浸润深度T 3~4者57例（90.5%），印戒细胞癌和黏液细胞癌19例（30.2%），淋巴结转移者57例（90.5%），远处转移者36例（57.1%）。29例（46.0%）进行根治性手术，12例行姑息性手术，5例仅行剖腹探查术，17例由于分期较晚无法手术。肿瘤TNM分期为Ⅲ~Ⅳ期者为56例（88.9%），其中51例（81.0%）接受化疗。同期收治的126例>40岁胃癌患者中，男性98例（77.8%)，女性28例（22.2%）；体质指数（23.8±3.2）kg/m 2。肿瘤为低分化者60例（47.6%），肿瘤浸润深度为T 3~4者90例（71.4%）；印戒细胞癌和黏液细胞癌16例（12.7%）；淋巴结转移79例（62.7%），远处转移12例（9.5%），接受根治性手术者115例（91.3%），肿瘤TNM分期Ⅲ~Ⅳ期者74例（58.7%），67例（53.2%）接受化疗。与同期>40岁胃癌患者比较，63例青少年胃癌患者体质指数更低，女性、低分化程度、印戒细胞癌和黏液细胞癌、肿瘤浸润深度T 3~4、淋巴结转移、远处转移、肿瘤TNM分期Ⅲ~Ⅳ期及接受化疗者比例更高（均 P<0.05）。52例（82.5%）青少年胃癌患者获得随访，中位随访72.1（36.1，100.8）个月。中位生存时间为10.4个月（95% CI：6.5~15.1），1、3和5年生存率分别为44.2%、25.0%和18.0%。单因素分析显示，肿瘤浸润深度（HR=7.15，95% CI：1.71~29.89， P=0.007）、淋巴结转移（HR=6.00，95% CI：1.42~25.42， P=0.015）、远处转移（HR=7.25，95% CI：3.25~16.18， P<0.001）、肿瘤TNM分期（HR=5.49，95% CI：1.67~18.12， P=0.005）和非根治性切除（HR=0.18，95% CI：0.09~0.37， P<0.001）与预后不良有关。多因素分析显示，仅远处转移是青少年胃癌生存的独立影响因素（HR=3.67，95% CI：1.32~10.19， P=0.012）。 结论:青少年胃癌分化程度差、诊断时多处于进展期、根治性切除比例低。有远处转移的青少年胃癌患者预后不良风险高。

Objective:Gastric cancer in adolescents is rare, with only a few cases reported in the literature. The purpose of this study is to investigate the clinicopathological features and prognostic factors of gastric cancer in adolescents aged 10-24 years.Methods:A case-controlled study was performed. The clinicopathological data of gastric cancer patients aged 10-24 years who were treated at the First Medical Center of Chinese PLA General Hospital from February 2000 to February 2017 were retrospectively collected and compared with those patients over 40 years old at the same period, which were randomly selected in a ratio of 1:2. All the patients were followed up until June 2019 and Cox proportional hazard model was used to analyze prognostic factors in the adolescent patients.Results:A total of 63 adolescent gastric cancer patients (0.4% of all 14 794 gastric cancer patients) were enrolled, including 31 males (49.2%) and 32 females (50.8%), with a mean body mass index of (19.5±4.3) kg/m 2. Before diagnosis, Only 35 cases (55.6%) had warning symptoms such as weight loss, ascites, obstruction, hematemesis, black stool, etc.; 5 cases (7.9%) had a family history of gastrointestinal tumor. The median duration of symptoms before diagnosis was 3 months. At diagnosis, 58 cases (92.1%) were poorly differentiated, 57 cases (90.5%) were T3-4 stage, 19 cases (30.2%) were signet ring cell cancer or mucous adenocarcinoma, 57 cases (90.5%) had lymph node metastasis, and 36 cases (57.1%) had distant metastasis. Twenty-nine patients (46.0%) underwent radical surgery, 12 patients underwent palliative surgery, 5 patients underwent exploratory laparotomy, 17 patients were unable to operate due to late stage. Of 56 cases (88.9%) with TNM stage Ⅲ-Ⅳ, 51 patients (81.0%) received chemotherapy. Of the 126 patients over 40 years old, 98 cases (77.8%) were male and 28 cases (22.2%) were female, and the mean body mass index was (23.8±3.2) kg/m 2. There were 60 cases (47.6%) with low differentiation, 90 cases (71.4%) with T3-4, 16 cases (12.7%) with signet ring cell cancer and mucous cell cancer, 79 cases (62.7%) with lymph node metastasis, and 12 cases (9.5%) with distant metastasis. A total of 115 cases (91.3%) underwent radical surgery. Of 74 cases (58.7%) with TNM stage Ⅲ-Ⅳ, 67 cases received (53.2%) chemotherapy. The 63 adolescent gastric cancer patients had lower body mass index, and higher proportion in female, poorly differentiation, signet ring cell cancer and mucous cell cancer, T3-4 stage, lymph node metastasis, distant metastasis, TNM stage Ⅲ-Ⅳ and receiving chemotherapy compared with 126 gastric cancer patients over 40 years old (all P<0.05). Among the 63 adolescent gastric cancer patients, 52 cases (82.5%) were followed up with median follow-up time of 72.1 (36.1, 100.8) months, and the median survival time was 10.4 months (95% CI: 6.5-15.1). The 1-year, 3-year and 5-year survival rates were 44.2%, 25.0% and 18.0%, respectively. Univariate analysis showed that the depth of tumor invasion (HR=7.15, 95% CI:1.71-29.89, P=0.007), lymph node metastasis (HR=6.00, 95% CI:1.42 - 25.42, P=0.015), distant metastasis (HR=7.25, 95% CI: 3.25 - 16.18, P<0.001), TNM stage (HR=5.49, 95% CI: 1.67-18.12, P=0.005) and tumor resection (HR=0.18, 95% CI: 0.09-0.37, P<0.001) were the risk factors affecting the prognosis of adolescent gastric cancer patients. Multivariate survival analysis showed that distant metastasis was an independent factor for gastric cancer survival in adolescents (HR=3.67, 95% CI: 1.32-10.19, P=0.012). Conclusions:Gastric cancer in adolescents is insidious and progresses rapidly. Most of them are in the advanced stage at diagnosis and have low rate of radical excision.