Early Onset Gastric Cancer No Longer Presents as an Advanced Disease with Ominous Prognosis

Abstract

Background: This study aimed to characterize the clinicopathological features and prognosis of early onset gastric carcinomas (EOGCs) in a sample of young Portuguese adults. Material and Methods: A subset of 415 patients submitted to gastric resection was divided into 2 groups: A – patients aged 45 years or less (n = 108), and B – patients older than 45 years (n = 307). The groups were compared for several clinicopathological features and the survival of the patients was analyzed by uni- and multivariate analysis. Results: The surgical resection rate was higher in young patients, in whom tumors more frequently displayed an ulcerative shape (p < 0.001) and diffuse/isolated cell-type histology (p < 0.001). In the elderly, the rate of vascular invasion was significantly higher (p = 0.002). Overall, the survival of young patients was higher than in the elderly (p < 0.001). Survival curves were higher in young patients, except for pT4 and pM1 cases. In the multivariate survival analysis, age (p < 0.001), depth of tumor invasion (p < 0.001), nodal status (p < 0.001), vascular invasion (p = 0.011) and distant metastases (p = 0.007) emerged as independent prognostic factors for gastric carcinoma. Conclusion: Young gastric cancer patients no longer present with more advanced disease than the elderly and, overall, survival is better in young patients.

Clinicopathological features and prognostic factors of gastric cancer patients aged 40 years or younger

“…Other studies have suggested that advanced disease stage and the presence of distant metastasis produce worse surgical outcomes 10. Furthermore, Moreira et al 20 found that tumor location, Carneiro's histological classification, depth of tumor invasion, lymphatic invasion, nodal involvement, vascular invasion, distant metastases, and stage in univariate analysis have significant impacts on survival. In the present study, advanced nodal involvement, deeper tumor invasion, bigger tumor size, and positive resection margins were independent factors for young patients with poorer survival by multivariate analysis (Table III, Fig.…”

“…Whether the prognosis of GC patients undergoing resection is influenced by age remains controversial 7, 9, 10, 20. Studies have shown that young patients have worse survival than old patients, but more advanced diseases have been noted in the young 9.…”

“…Studies have shown that young patients have worse survival than old patients, but more advanced diseases have been noted in the young 9. In contrast, Moreira et al 20 found that young patients with GC have more favorable outcomes than older patients when matched for tumor stage. Moreover, Santoro et al revealed that although GC tends to be more advanced in younger patients, their prognosis does not differ from that of older patients 10.…”

Clinical Outcomes of Endoscopic Submucosal Dissection in Patients under 40 Years Old with Early Gastric Cancer

“…However, a few subsequent studies reported that the prognosis and survival rate were not significantly different between young and older patients after matching for tumor stage. 3,13,18 Furthermore, the prognosis and survival rate of young patients after curative resection were better than those of older patients. [5][6][7]9,13 Owing to awareness about aggressive tumor biology and rapid progression in young patients with gastric cancer, there were concerns about endoscopic local treatment in young patients with EGC, even for those that met the expanded indication for ESD.…”

Gastric Adenocarcinoma Presenting as Thrombotic Microangiopathy in a 14-year-old Girl

“…This suggests the importance of developing a thorough investigation of at-risk individuals and young patients who present with gastric symptoms, as the main strategy to detect early-stage disease. 13 In particular, the endoscopic examination of patients with a high clinical suspicion of gastric cancer, especially with a positive familial history, is recommended.…”