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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)
See this image and copyright information in PMC

References

    1. Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet. 2020;396:635–48. - PubMed
    1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86. - PubMed
    1. Group. USCSW. U.S. Cancer Statistics Data Visualizations Tool, based on 2021 submission data (1999-2019). US Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; wwwcdcgov/cancer/dataviz. 2022.
    1. Collaborative R, Zaborowski AM, Abdile A, Adamina M, Aigner F, d'Allens L. et al. Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review. JAMA Surg. 2021;156:865–74. - PubMed
    1. Kulig P, Nowakowski P, Sierzega M, Pach R, Majewska O, Markiewicz A. et al. Analysis of Prognostic Factors Affecting Short-term and Long-term Outcomes of Gastric Cancer Resection. Anticancer Res. 2021;41:3523–34. - PubMed