Characteristics and prognosis of gastric cancer in young patients

Abstract

The clinicopathological features of gastric cancer (GC) differ between younger and older patients, and it is thought that younger patients have a worse prognosis than older patients due to delayed diagnosis and more aggressive tumor behavior. These characteristics, however, remain controversial. A total of 3,818 patients with pathologically confirmed primary gastric adenocarcinoma were treated at our institution. We analyzed the difference in demographic and clinicopathological characteristics between 169 young [≤40 years of age, younger group (YG)] and 3,649 older [>40 years of age, older group (OG)] GC patients. There was a significantly higher proportion of females in the YG compared with the OG (53.3 and 31.0%, respectively; P<0.0001). The 5-year overall survival of the YG was significantly lower compared to that of the OG (59.7 and 65.9%, respectively; P=0.049). However, YG patients with curative resection had a similar 5-year survival rate to OG patients with curative resection (88.0 and 85.8%, respectively; P=0.547). Female patients in the YG showed a significantly lower survival rate than males in the YG (44.3 and 73.1%, respectively; P=0.0002). Multivariate analyses revealed that macroscopic type, depth of invasion, peritoneal metastasis, distant metastasis and curative resection were independent prognostic factors for the YG with GC. Young GC patients who undergo curative resection do not have a worse prognosis than older patients. Early diagnosis is important in successfully carrying out a curative resection and offering a better prognosis, particularly in females.

Figure 1

Distribution of gender frequency, undifferentiated cancer type, stage IV disease and 5-year survival were examined to define the appropriate age groups for comparison.

Figure 2

Survival curves according to age for the younger group (YG) and the older group (OG). (A) All patients and (B) patients with curative resection.

Figure 2

Survival curves according to age for the younger group (YG) and the older group (OG). (A) All patients and (B) patients with curative resection.

Figure 3

Survival curves according to gender. (A) All patients, (B) older group (OG) and (C) younger group (YG).

Figure 3

Survival curves according to gender. (A) All patients, (B) older group (OG) and (C) younger group (YG).

Figure 3

Survival curves according to gender. (A) All patients, (B) older group (OG) and (C) younger group (YG).

Figure 4

Survival curves according to stage for the younger group (YG, solid line) and the older group (OG, dashed line). The 5-year survival rate of the YG and OG at stage I (100 vs. 97.3%, P=0.181), stage II (68.6 vs. 76.7%, P=0.286) and stage III (36.6 vs. 37.4%, P=0.760). The 2-year survival rate of the YG and OG at stage IV was 4.4 vs. 10.4% (P=0.612).

Figure 5

Survival curves for the younger group (YG) according to stage on patients treated with chemotherapy (CG, solid line) and patients not treated with chemotherapy (NCG, dashed line). The 5-year survival rate of the CG and NCG at stage II was 70.3 vs. 75.0% (P=0.646) and at stage III was 38.5 vs. 42.2% (P=0.568). The 2-year survival rate of the CG and NCG at stage IV was 6.7 vs. 0% (P=0.612).