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. 2023 May 21;14(9):1470-1478.
doi: 10.7150/jca.82876. eCollection 2023.

Clinical Characteristics and Oncological Outcomes of Surgically Treated Early-Onset Gastric Adenocarcinoma - a Retrospective Cohort Study

Ingmar F Rompen  1 , Henrik Nienhüser  1 , Nerma Crnovrsanin  1 , Julian Musa  1   2 , Georg Martin Haag  3 , Thomas Longerich  4 , Timon Fiedler  4 , Beat P Müller-Stich  1 , Leila Sisic  1 , Adrian T Billeter  1
Affiliations

Clinical Characteristics and Oncological Outcomes of Surgically Treated Early-Onset Gastric Adenocarcinoma - a Retrospective Cohort Study

Ingmar F Rompen et al. J Cancer. .

Abstract

Introduction: The incidence of early-onset gastric adenocarcinoma (patients <50 years, EOGA) is rising. Tumors in younger patients are associated with prognostically unfavorable features. The impact of EOGA on patient survival, however, remains unclear. The aim of this study is to evaluate early-onset age as a prognostic factor compared to late-onset gastric adenocarcinoma (LOGA, >50years) in a surgical cohort and assess treatment options. Methods: We analyzed 738 patients (129 early-onset/609 late-onset) operated in curative intent from 2002 to 2021. Data was extracted from a prospectively managed database of an academic tertiary referral hospital. Differences in perioperative as well as oncological outcomes were calculated by chi-square test. Cox regression analysis was performed to assess disease-free survival (DFS) and overall survival (OS). Results: EOGA patients were more often treated with neoadjuvant therapy (62.8% vs. 43.7%, p<0.001) and extended surgical resections e.g. through additional resections (36.4% vs. 26.8%, p=0.027). EOGA was more often metastasized into regional lymph nodes (pN+ 67.4% vs. 55.3%, p=0.012) and to distant sites (pM+: 23.3% vs. 12.0%, p=0.001) and was more often poorly differentiated (G3/G4: 91.1% vs. 67.2%, p<0.001). There were no significant differences in overall complication rates (31.0% vs. 36.6%, p=0.227). Survival analysis showed shorter DFS (median DFS 25.6 months vs. not reached, p=0.006) but similar OS (median OS: 50.5 months vs. not reached, p=0.920) in EOGA compared to LOGA. Conclusions: This analysis confirmed that EOGA is associated with more aggressive tumor characteristics. Early-Onset was not a prognostic factor in the multivariate analysis. EOGA patients may be more capable to undergo intensive multimodal therapy including perioperative chemotherapy and extended surgery.

Keywords: adenocarcinoma; early-onset; gastric cancer; surgery; young.

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Conflict of interest statement

Competing Interests: G.M. H. reported to having received the following funding unrelated to this manuscript: Consulting or Advisory Role: Bristol-Myers Squibb; MSD Sharp & Dohme; Lilly; Novartis; Daiichi Sankyo. Honoraria: Servier; MSD Sharp & Dohme; Lilly; Targos; Bristol-Myers Squibb; IOMEDICO, MCI Conventions. Research Funding (not related to this manuscript): Nordic Pharma; Taiho Pharmaceutical; MSD Sharp & Dohme; Janssen; Astra Zeneca; Bristol-Myers Squibb; IKF Klinische Krebsforschung Frankfurt. Travel; Accommodations: Bristol-Myers Squibb; Lilly; Servier; MSD Sharp & Dohme. All other authors stated no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan-Meyer Curve of Disease-Free Survival. Time in months, p calculated by log-rank test
Figure 2
Figure 2
Multivariate Analysis of DFS. Neoadjuvant = neoadjuvant Chemotherapy or Radio-Chemotherapy, OP_Type = subtotal gastrectomy vs. total gastrectomy with or withour transhiatal distal esophagectomy, Stage = UICC-Stages I-IV, LNR = Lymph-Node-Ratio (fraction of lymph nodes with malignant cells)
Figure 3
Figure 3
Kaplan-Meyer Curve of Overall survival. Time in months, p calculated by log-rank test
Figure 4
Figure 4
Multivariate Analysis of OS. ASA = American Society of Anesthesiologists physical status classification system I-VI, OP_Type = subtotal gastrectomy vs. total gastrectomy with or withour transhiatal distal esophagectomy, Stage = pUICC-Stages I-IV, LNR = Lymph-Node-Ratio (fraction of lymph nodes with malignant cells)
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