Endoscopic, clinicopathological features and prognosis of very young patients with gastric cancer

Abstract

The study describes that very young patients with gastric cancer were mainly females, who were less likely to present with alarm features, but had a high frequency of family history of gastric cancer; and the majority of these cancers were located in gastric body, and they had similar long-term prognosis compared with elderly counterparts if curative surgical resection was performed.

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

“…1 However, most previous studies on young gastric cancer patients showed a female predominance, with a lower male-to-female sex ratio (0.54:1∼1.26:1). 3,6,9,10,13 The male-to-female sex ratio of young gastric patients who underwent ESD was 0.77:1 in our study. This corresponds to findings in young gastric patients with not only advanced stage but also early stage of disease.…”

“…14,15 Especially, a positive family history of gastric cancer correlates with younger age, 15 and the rate of positive family history of gastric cancer in young gastric cancer patients ranged from 5.9% to 19.3%. 3,6,10,13 Like other studies on young gastric cancer patients including those with advanced-stage gastric cancer, relatively higher rates of young patients with early-stage disease (12.5%) had a positive family history of gastric cancer in first-degree relatives, and less than half the patients had a smoking history and about half of the patients had a history of alcohol consumption. In previous studies, tumors located in the middle third, with a flat or depressed morphology, of the diffuse type according to Lauren's classification, and with undifferentiated type histology were more common in young gastric cancer patients than in older patients.…”

“…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.…”

“…9 The percentages of tumors located in the middle and upper thirds were reported 41.4% and 20.1% in Japan, 6 similar to that reported in China (60.0% in the middle and upper thirds). 13 The tumors of young gastric cancer patients at an advanced stage were located more commonly in the upper or middle third, compared with that in young EGC patients who underwent ESD. In previous studies, the prognosis of young patients was poorer and the survival rate was lower than those of older patients.…”

“…In previous studies, tumors located in the middle third, with a flat or depressed morphology, of the diffuse type according to Lauren's classification, and with undifferentiated type histology were more common in young gastric cancer patients than in older patients. 3,6,10,13 Similarly, tumors with a flat or depressed morphology and undifferentiated type histology were common in young gastric patients who underwent ESD. The predominance of the undifferentiated type of cancer was one of the significant characteristics in young gastric cancer patients not only with advanced-stage but also those with early-stage disease.…”