Clinicopathological characteristics of gastric carcinoma in young patients

Unveiling the Younger Face of Gastric Cancer: A Comprehensive Review of Epidemiology, Risk Factors, and Prevention Strategies

Gastric cancer poses a significant global health challenge, with high incidence and mortality rates each year. Despite advancements in screening and treatment, late detection remains a critical issue. Efforts to address this include raising public awareness and implementing targeted screening programs for high-risk populations. The increasing incidence of gastric cancer among younger individuals underscores the need for lifestyle adjustments and targeted interventions to mitigate risks and improve outcomes. Understanding the various factors contributing to gastric cancer risk is essential for effective prevention strategies, including Helicobacter pylori eradication, lifestyle modifications, and regular screening for high-risk groups. A comprehensive approach addressing both individual behaviors and broader societal factors is crucial in the fight against gastric cancer. This review provides an in-depth examination of gastric cancer epidemiology, risk factors, preventive measures, and screening initiatives, with a particular focus on the rising incidence among younger demographics. Emphasizing the importance of early detection and intervention, the review highlights the need for proactive screening to improve patient outcomes and reduce mortality rates. By addressing these aspects comprehensively, this paper aims to enhance the understanding of gastric cancer dynamics, particularly its incidence among younger individuals, and to inform future strategies for prevention and control.

Analysis of clinicopathologic characteristics and prognosis of gastric cancer in patients <40 years

An increase trend and a bad prognosis toward gastric cancer (GC) in individuals <40 years have been observed over the past few decades. GC in Young adult needs further evaluation to identify clear risk factors for early screening and better prognosis. A total of 126 young adult patients with gastric cancer (individuals <40 years) (YG) were collected in Liaocheng hospital in China from Jan 2003 to Dec 2019. The overall median follow-up was 96.5 months (rang 1-192 months). Survival was determined by the Kaplan-Meier method and the difference in survival among different subgroups were assessed using the log-lank test. Correlations between risk factors and overall survival were assessed by univariate and multivariate Cox proportional hazards regression analysis. Advanced stage cancer at onset and undifferentiated histologic tumor type were the prominent clinicopathological features of YG. The 5-year overall survival of the YG was 31.7%. The 5-year survival of the YG differed from tumor staging and treatment methods. The 5-year survival was 100% in stage I group, 58.8% in stage II group, 22.6% in stage III group, and 8.3% in stage IV group respectively. The 5-year survival was 52.1% in the curative resection group versus 3.8% in the non-curative resection group. Multivariate analysis displayed that tumor staging (P = .002) and treatment method (P = .034) were 2 independent prognostic predictors for survival. GC in young adult patients have unique clinicopathological features. Upper gastrointestinal endoscopy should regularly perform for young adult especially those symptomatic patients. Early diagnosis and then proceed to a successful curative resection are vital for a better prognosis.

Comparisons of pathologic findings and outcomes of gastric cancer patients younger and older than 40: a propensity score matching study in a single center of Korea

Background and Aim

Gastric cancer (GC) is one of the most common cancers worldwide, with a high incidence rate in Korean men. However, comparative studies are scarce on the pathologic findings and treatment effects of GC in patients aged less than 40 years. We evaluated the characteristics and pathologic findings of GC patients aged younger and older than 40 years.

Methods

We retrospectively analyzed 2307 patients diagnosed with GC between January 2010 and May 2018. Eighty-eight (3.8%) and 2219 (96.2%) patients were younger and older than 40 years, respectively. The patients were divided into younger (n = 70) and older (n = 62) age groups through propensity matching.

Results

Overall, compared to the younger group, the older group (n = 2219) had a significantly higher proportion of male patients (66.7% vs 39.8%; P < 0.001) and patients who underwent endoscopic submucosal dissection (ESD) (2.3% vs 23.1%; P < 0.001). However, young patients more often underwent operations compared to older patients (78.4% vs 60.1%; P = 0.001). In the propensity-matched group, older patients more often showed differentiated carcinoma, including well-differentiated (5.7% vs 11.3%) and moderately differentiated (1.4% vs 32.3%). However, younger patients more often showed signet ring cell carcinoma (SRC) (70.0% vs 25.8%). In multivariate analysis, Helicobacter pylori infection (odds ratio, 12.643; 95% confidence interval, 1.068-1449.665; P = 0.044) independently correlated with SRC risk.

Conclusions

Patients below 40 years were more likely to undergo surgery compared to ESD, and pathologic findings were more common in SRC. Therefore, more active screening and H. pylori eradication are needed even in patients aged less than 40 years.

Specifics of Young Gastric Cancer Patients: A Population-Based Analysis of 46,110 Patients with Gastric Cancer from the German Clinical Cancer Registry Group

Introduction: 2−8% of all gastric cancer occurs at a younger age, also known as early-onset gastric cancer (EOGC). The aim of the present work was to use clinical registry data to classify and characterize the young cohort of patients with gastric cancer more precisely. Methods: German Cancer Registry Group of the Society of German Tumor Centers—Network for Care, Quality and Research in Oncology (ADT)was queried for patients with gastric cancer from 2000−2016. An approach that stratified relative distributions of histological subtypes of gastric adenocarcinoma according to age percentiles was used to define and characterize EOGC. Demographics, tumor characteristics, treatment and survival were analyzed. Results: A total of 46,110 patients were included. Comparison of different groups of age with incidences of histological subtypes showed that incidence of signet ring cell carcinoma (SRCC) increased with decreasing age and exceeded pooled incidences of diffuse and intestinal type tumors in the youngest 20% of patients. We selected this group with median age of 53 as EOGC. The proportion of female patients was lower in EOGC than that of elderly patients (43% versus 45%; p < 0.001). EOGC presented more advanced and undifferentiated tumors with G3/4 stages in 77% versus 62%, T3/4 stages in 51% versus 48%, nodal positive tumors in 57% versus 53% and metastasis in 35% versus 30% (p < 0.001) and received less curative treatment (42% versus 52%; p < 0.001). Survival of EOGC was significantly better (five-years survival: 44% versus 31% (p < 0.0001), with age as independent predictor of better survival (HR 0.61; p < 0.0001). Conclusion: With this population-based registry study we were able to objectively define a cohort of patients referred to as EOGC. Despite more aggressive/advanced tumors and less curative treatment, survival was significantly better compared to elderly patients, and age was identified as an independent predictor for better survival.

The Burden of Peritoneal Metastases from Gastric Cancer: A Systematic Review on the Incidence, Risk Factors and Survival

The peritoneum is a common metastatic site in gastric cancer. This systematic review provides an overview of the incidence, risk factors and survival of synchronous peritoneal metastases from gastric cancer. A systematic search was performed to identify studies wherein the incidence, risk factors and survival of gastric cancer with peritoneal metastases were investigated. Of all 38 potentially eligible studies, 17 studies were included based on the eligibility criteria. The incidence of synchronous gastric peritoneal metastases was reviewed for population-based studies (10–21%), for observational cohort studies (2–15%) and for surgical cohort studies (13–40%). Potential risk factors for synchronous gastric peritoneal metastases were younger age, non-cardia gastric cancer, female sex, signet ring cell carcinoma, diffuse type histology or linitis plastica, T4 stage, Hispanic ethnicity and more than one metastatic location. Synchronous peritoneal metastases are commonly diagnosed in patients with gastric cancer with an incidence up to 21% in recent population-based studies. Furthermore, prognosis of patients with gastric peritoneal metastases is poor with median overall survival ranging from 2 to 9 months. The high incidence and poor prognosis require intensive research on diagnostic features and effective treatment options to improve survival.

Comparative investigation of early-onset gastric cancer

Early-onset gastric cancer (EOGC) is a serious social burden. For patients with EOGC, typically considered as those aged <45 years, the underlying cause of the disease remains unclear. In addition, several misunderstandings of EOGC remain in clinical practice. Upon diagnosis, numerous patients with EOGC are already at an advanced stage (stage IV) of the disease and are unable to benefit from treatment. Moreover, several conclusions and data obtained from different EOGC studies appear to be to contradictory. The literature indicates that the incidence of EOGC is gradually rising, and that EOGC differs from traditional and familial gastric cancer in terms of clinicopathological characteristics. Patients with EOGC typically exhibit low survival rates, poor prognosis, rapid disease progression, a low degree of differentiation (signet-ring cell tumors are common) and rapid lymph node and distant metastasis, among other characteristics. The molecular genetic mechanisms of EOGC are also significantly different from those of traditional gastric cancer. An improved definition of EOCG may provide a reference for clinical diagnosis and treatment, and clear guidelines may serve as a basis for more accurate diagnosis and the development of effective treatment strategies.

Gastric Carcinoma in Young Patients and Its Clinicopathological Characteristics and Prognosis

Background

Gastric cancer is usually an age-related disease and mostly diagnosed after the sixth decade of life, though it may also be diagnosed earlier.

Objective

The aim of this study is to explore the clinicopathological characteristics and prognosis of gastric carcinoma in young patients.

Methods

A total of 1379 patients younger than 75 years histologically diagnosed with primary gastric carcinoma underwent gastrectomy. Patients were categorized into three groups based on their age which included young age group (≤40 years), middle-aged group (age 41-60 years), and elderly group (age 61-75 years). The young age group was further subdivided into two groups: Group A (age ≤35 years) and Group B (age 35-40 years). The analysis of the clinicopathological characteristics and prognosis followed thereafter.

Results

Females predominate in young group (p < 0.001). A significantly higher undifferentiated histological pattern was found in the young age group from the other two groups (p < 0.001). Tumor location in the lower third of the stomach was significantly higher in the young group than the other groups (p < 0.001). T4 stage was common in young patients similar to the middle and old age group (p = 0.049). Distal gastrectomy was performed more in the young age group rather than the middle and old age groups with the following percentage ratios: young group 74.5% (123/165), middle age group 59.9% (429/716), and old age group 52.2% (260/498) (p < 0.001). The 5-year overall survival rate of the young, middle, and old age groups were 46%, 48%, and 39%, respectively, whereas the 5-year overall survival rates of the subgroups of young patients, Group A and Group B, were 33% and 49%, respectively. Multivariate analysis revealed that independent negative prognostic factors were as follows: tumor location (L), p = 0.016, OR = 0.795, 95%CI = [0.659; 0.959]; larger tumor size, p = 0.026, OR = 1.727, 95%CI = [1.067; 2.797]; resection margin, p < 0.001, OR = 2.167, 95%CI = [1.751; 2.682]; tumor stage (T4), p < 0.001, OR = 2.572, 95%CI = [1.709; 3.870]; and nodal involvement N1, p = 0.005, OR = 1.506, 95%CI = [1.123; 2.020]; N2, p < 0.001, OR = 1.708, 95%CI = [1.289; 2.263]; and N3, p < 0.001, OR = 2.986, 95%CI = [2.314; 3.854].

Conclusion

The young age groups of patients were predominantly female and had a higher proportion of poorly differentiated and undifferentiated type of tumor; moreover, patients aged <35 years had a poor prognosis. In addition, gastric cancer can occur in patients less than 30 years old, and symptoms suggestive of gastric cancer should be investigated aggressively; therefore, a close scrutiny and monitoring should be done in younger patients especially those associated with high-risk factors which could indicate the presence of the disease at an early stage.

Gastric Carcinoma in Young Patients and Its Clinicopathological Characteristics and Prognosis

Background. Gastric cancer is usually an age-related disease and mostly diagnosed after the sixth decade of life, though it may also be diagnosed earlier. Objective. The aim of this study is to explore the clinicopathological characteristics and prognosis of gastric carcinoma in young patients. Methods. A total of 1379 patients younger than 75 years histologically diagnosed with primary gastric carcinoma underwent gastrectomy. Patients were categorized into three groups based on their age which included young age group (≤40 years), middle-aged group (age 41-60 years), and elderly group (age 61-75 years). The young age group was further subdivided into two groups: Group A (age ≤35 years) and Group B (age 35-40 years). The analysis of the clinicopathological characteristics and prognosis followed thereafter. Results. Females predominate in young group (p<0.001). A significantly higher undifferentiated histological pattern was found in the young age group from the other two groups (p<0.001). Tumor location in the lower third of the stomach was significantly higher in the young group than the other groups (p<0.001). T4 stage was common in young patients similar to the middle and old age group (p=0.049). Distal gastrectomy was performed more in the young age group rather than the middle and old age groups with the following percentage ratios: young group 74.5% (123/165), middle age group 59.9% (429/716), and old age group 52.2% (260/498) (p<0.001). The 5-year overall survival rate of the young, middle, and old age groups were 46%, 48%, and 39%, respectively, whereas the 5-year overall survival rates of the subgroups of young patients, Group A and Group B, were 33% and 49%, respectively. Multivariate analysis revealed that independent negative prognostic factors were as follows: tumor location (L), p=0.016, OR=0.795, 95%CI=0.659;0.959; larger tumor size, p=0.026, OR=1.727, 95%CI=1.067;2.797; resection margin, p<0.001, OR=2.167, 95%CI=1.751;2.682; tumor stage (T4), p<0.001, OR=2.572, 95%CI=1.709;3.870; and nodal involvement N1, p=0.005, OR=1.506, 95%CI=1.123;2.020; N2, p<0.001, OR=1.708, 95%CI=1.289;2.263; and N3, p<0.001, OR=2.986, 95%CI=2.314;3.854. Conclusion. The young age groups of patients were predominantly female and had a higher proportion of poorly differentiated and undifferentiated type of tumor; moreover, patients aged <35 years had a poor prognosis. In addition, gastric cancer can occur in patients less than 30 years old, and symptoms suggestive of gastric cancer should be investigated aggressively; therefore, a close scrutiny and monitoring should be done in younger patients especially those associated with high-risk factors which could indicate the presence of the disease at an early stage.

Gastric Carcinoma in Young Patients and Its Clinicopathological Characteristics and Prognosis

Background. Gastric cancer is usually an age-related disease and mostly diagnosed after the sixth decade of life, though it may also be diagnosed earlier. Objective. The aim of this study is to explore the clinicopathological characteristics and prognosis of gastric carcinoma in young patients. Methods. A total of 1379 patients younger than 75 years histologically diagnosed with primary gastric carcinoma underwent gastrectomy. Patients were categorized into three groups based on their age which included young age group (≤40 years), middle-aged group (age 41-60 years), and elderly group (age 61-75 years). The young age group was further subdivided into two groups: Group A (age ≤35 years) and Group B (age 35-40 years). The analysis of the clinicopathological characteristics and prognosis followed thereafter. Results. Females predominate in young group (p<0.001). A significantly higher undifferentiated histological pattern was found in the young age group from the other two groups (p<0.001). Tumor location in the lower third of the stomach was significantly higher in the young group than the other groups (p<0.001). T4 stage was common in young patients similar to the middle and old age group (p=0.049). Distal gastrectomy was performed more in the young age group rather than the middle and old age groups with the following percentage ratios: young group 74.5% (123/165), middle age group 59.9% (429/716), and old age group 52.2% (260/498) (p<0.001). The 5-year overall survival rate of the young, middle, and old age groups were 46%, 48%, and 39%, respectively, whereas the 5-year overall survival rates of the subgroups of young patients, Group A and Group B, were 33% and 49%, respectively. Multivariate analysis revealed that independent negative prognostic factors were as follows: tumor location (L), p=0.016, OR=0.795, 95%CI=0.659;0.959; larger tumor size, p=0.026, OR=1.727, 95%CI=1.067;2.797; resection margin, p<0.001, OR=2.167, 95%CI=1.751;2.682; tumor stage (T4), p<0.001, OR=2.572, 95%CI=1.709;3.870; and nodal involvement N1, p=0.005, OR=1.506, 95%CI=1.123;2.020; N2, p<0.001, OR=1.708, 95%CI=1.289;2.263; and N3, p<0.001, OR=2.986, 95%CI=2.314;3.854. Conclusion. The young age groups of patients were predominantly female and had a higher proportion of poorly differentiated and undifferentiated type of tumor; moreover, patients aged <35 years had a poor prognosis. In addition, gastric cancer can occur in patients less than 30 years old, and symptoms suggestive of gastric cancer should be investigated aggressively; therefore, a close scrutiny and monitoring should be done in younger patients especially those associated with high-risk factors which could indicate the presence of the disease at an early stage.

More attention should be paid to adult gastric cancer patients younger than 35 years old: extremely poor prognosis was found

Purpose: Several studies have reported controversial results about prognosis of gastric cancer in young age patients. The difference may partially result from variable definitions of young age. The aim of this study was to find out the relation between age and prognosis of gastric cancer patients, and to analyze the clinicopathological features and prognostic factors in young gastric cancer patients.

Methods: Data queried for this analysis included GC patients from the Surveillance, Epidemiology, and End Results Program database from 1973 to 2014. Gastric cancer patients (N=79,505) diagnosed with an age≥18 were included. By combining patients with similar prognosis, we figured out 3 cutoff values of age, 35 years old, 65 years old and 75 years old. We divided patients into 4 groups: young age patients: 18-34 years; middle-age patients: 35-64 years; elderly patients: 65-74 years; extremely elderly patients: >74 years. GC patients from Sun Yat-sen University Cancer Center (SYSUCC) were used as external validation data.

Results: The clinicopathological features of young age gastric cancer patients included: poor-differentiated, diffuse type of cancer, and advanced stage at diagnosis. The median survival of patients <35 years old was significantly lower than middle-age patients (35-64 years) and elderly patients (65-74 years) (12 months vs. 15 and 16 months, respectively, both p <0.001). Location of tumor, ethnicity, tumor size, surgery and TNM stage were independent prognostic factors by multivariate analysis in young patients. The poor prognosis for young patients remained valid in the SYSUCC database.

Conclusions: Our results demonstrated that gastric cancer patients <35 years old had an extremely poor prognosis. Early detection of gastric cancer is of paramount importance in young age people.

The prognostic value of age in non-metastatic gastric cancer after gastrectomy: a retrospective study in the U.S. and China

Purpose: We explored the influence of age on clinicopathologic features and survival of patients with M0 gastric cancer (GC).

Methods: 16856 GC patients from Surveillance, Epidemiology and End Results (SEER) database and 1037 GC patients from Chinese multiple centers were enrolled in the U.S. and Chinese cohort, respectively. 50-year-old was treated as cutoff age. Propensity score method was used to carry out a 1:1 paired match.

Results: In the U.S. cohort, we found that younger patients presented poor tumor behavior. However, in spite of worse outcome in stage I~IV cohort, young group showed better 3-year survival in M0 patients, especially for those who underwent a total gastrectomy. In a matched analysis, a better prognosis was still observed in younger group. The prognostic value of age was also validated in M0 GC patients with gastrectomy in Chinese cohort.

Conclusions: In spite of the worse outcome in survival curve of stage I~IV GC cohort, young patients with gastrectomy presented favorable survival in M0 subgroup. It is also applicable in China. Early diagnosis and treatment should be taken seriously in young GC patients since they often possess poorer characteristics but benefited more from gastrectomy.

A rising trend in the incidence of advanced gastric cancer in young Hispanic men

BACKGROUND

Although the incidence of gastric cancer has been decreasing, recent reports suggest an increased rate in select populations. We sought to evaluate trends in gastric cancer incidence to identify high-risk populations.

METHODS

Gastric cancer incidence rates from 1992 to 2011 were computed with use of the Surveillance, Epidemiology, and End Results (SEER) registry. We evaluated trends in incidence rates by calculating the annual percent change (APC) across three age groups (20-49 years, 50-64 years, and 65 years or older) and four racial/ethnic groups (Hispanics, non-Hispanic whites, blacks, and Asian/Pacific Islanders).

RESULTS

We identified 41,428 patients with gastric cancer. For the entire cohort during the study period, the APC was decreased. When patients were grouped according to sex, the APC was flat or decreased in women regardless of age or race/ethnicity. The APC was also flat or decreased for all men except young Hispanic men (20-49 years), who had an increased APC of nearly 1.6 % (1.55 %, 95 % confidence interval 0.26-2.86 %). Furthermore, young Hispanic men were the only group to have increased incidence of stage IV disease (APC 4.34 %, 95 % confidence interval 2.76-5.94 %) and poorly differentiated tumors (APC 2.08 %, 95 % confidence interval 0.48-3.70 %).

CONCLUSIONS

The APC of the incidence of gastric cancer in young Hispanic men places it among the top cancers with rising incidence in the USA. This is concomitant with increased incidence of advanced disease at presentation. This major public health concern warrants additional research to determine the cause of the increasing incidence in this group.

Gastric cancer in the young: An advanced disease with poor prognostic features

BACKGROUND AND OBJECTIVES

Gastric cancer in young patients is rare. We analyzed the clinicopathological features and prognosis of early-onset gastric carcinoma.

METHODS

We retrospectively reviewed patients with gastric adenocarcinoma aged ≤45 years and >45 years at our institution over a 17-year period. Clinicopathological features were compared and survival analysis was performed using Kaplan-Meier curves.

RESULTS

A total of 121 patients with gastric carcinoma aged ≤45 years were identified. The young group (YG) had a higher incidence of stage III/IV disease (86.8% vs. 57.9%, P < 0.001), poorly-differentiated carcinoma (95.9% vs. 74.4%, P < 0.001), and signet-cell type tumor (88.4% vs. 32.2%, P < 0.001) relative to the older group (OG). The majority of tumors were in the middle third of the stomach in both groups (P = 0.108). Three-year survival in the YG was 87.1%, 32.2%, and 6.9% in stage I/II, III, and IV disease, respectively. Surgical intervention in young patients with advanced carcinoma was not associated with improved survival. Although median survival was shorter in the YG compared to the OG (11.7 vs. 41.0 months, P < 0.001), stage-specific survival was similar.

CONCLUSION

Early-onset gastric cancer demonstrates advanced stage of disease, and a high incidence of poorly-differentiated and signet-cell type carcinoma. Overall survival is poor with no added benefit to surgical intervention in advanced disease.

Comparison of the Expression of Cell Adhesion Molecule Markers (E-Cadherin and Syndecan-1) between Young and Older Age Patients with Gastric Carcinoma

AIM

The aim of this study was to evaluate the relationship between age and cell adhesion molecule markers (E-cadherin and syndecan-1).

MATERIALS AND METHODS

Forty-three cases of gastric carcinoma below the age of 50 were referred to our center in the period of 5 years (2003–2008). Forty-three gastric carcinoma above the age of 50 years were sex-matched with the first group. Expression of syndecan-1 and E-cadherin were evaluated by immunohistochemistry in a total of 86 gastric carcinomas accompanying with all the clinicopathological findings in each case.

RESULTS

The expression of syndecan-1 and E-cadherin did not show significant difference between two age groups; in addition, there were no significant differences in all the clinicopathological findings in these two age groups.

DISCUSSION

Gastric carcinoma in young and old age adults showed no significant difference in respect of the expression of cell adhesion molecule markers. Our result shows that young age alone cannot be predictive of more metastasis and invasion potential.

Induced nitric oxide synthetase and peroxiredoxin expression in intramucosal poorly differentiated gastric cancer of young patients

To investigate the relationship between oxidative stress and gastric carcinogenesis of poorly differentiated adenocarcinoma in young patients, we analyzed the surgically resected specimens of 22 young patients (21-30 years) and 29 older patients (41-72 years) with intramucosal gastric cancer of the poorly differentiated type. We used immunohistochemical staining to evaluate the expression of 8-hydroxydeoxyguanosine (8OHdG), induced nitric oxide synthetase (iNOS), and antioxidant enzymes (thioredoxin [TRX] and peroxiredoxin [PRDX1, 2 and 3]). We assessed these proteins in the cancer, noncancerous gastric foveolar epithelium and noncancerous mucosal neck. In both the young and older patient groups, the 8OHdG and TRX expressions were gradually increased in cancer cells compared with the noncancerous foveolar epithelial cells and the noncancerous mucosal neck cells (P < 0.001). Although the iNOS and PRDXs expressions were increased in the noncancerous mucosal neck cells compared with the noncancerous foveolar epithelial cells, regardless of age (P < 0.001), the iNOS and PRDX2 expression in the cancer cells were significantly reduced in the young patients compared with the older patients (P < 0.001, P < 0.05). In conclusion, the reduced expression of iNOS or PRDX2 may play an important role in the carcinogenesis of gastric cancer associated with Helicobacter pylori-induced chronic active gastritis in young patients.

Clinical characteristics and outcomes for gastric cancer patients aged 18-30 years

BACKGROUND

There is little known about the clinicopathological features and the predictors of survival in extremely young adult patients aged 18-30 years. The aim of this study was to identify clinicopathological features and clinical outcomes for the overall population and for a resectable subgroup of gastric cancer patients aged 18-30 years.

METHODS

From January 2004 to December 2010, 207 patients aged between 18 and 30 years old were diagnosed with gastric cancer and treated at the Asan Medical Center. Clinical findings, histopathological parameters and outcomes were reviewed retrospectively. Patients were further divided into 2 groups according to tumor resectability and then clinicopathological factors that affect tumor resectability and clinical outcomes were analyzed.

RESULTS

Clinicopathological characteristics of study population showed a predominance of females, undifferentiated tumors, diffuse-type cancers, and advanced gastric cancer. The overall resectability rate was 70.0 % and the median follow-up period was significantly longer in the resectable tumor group (P < 0.001). Significant prognostic predictors for overall survival in overall patients were higher CEA levels (P = 0.016), larger tumor size (P < 0.001), unresectability (P = 0.006), and presence of lymphovascular invasion (P = 0.012) in a multivariate analysis. Significant prognostic factors for overall survival in patients with resectable disease included larger tumor size (>4 cm), lymphovascular invasion and higher CEA level in the multivariate analysis.

CONCLUSIONS

Gastric adenocarcinomas in young adult patients aged 18-30 years have unique clinicopathological features. Early detection in a resectable state and subsequent complete resection could increase survival period in young patients with gastric cancer.

Gastric cancer-a clinicopathological study in a tertiary care centre of North-eastern India

BACKGROUND

The incidence of gastric cancer varies in different parts of the world and among various ethnic groups. It remains the fifth most common cancer among males and seventh most common cancer among females in India.

MATERIALS AND METHODS

We conducted a retrospective study using the data base of 158 patients of primary gastric cancer diagnosed in the Department of Surgery at Regional Cancer Centre, RIMS, Manipur, India from July 2009 to June 2013.

RESULTS

Our study revealed a male to female ratio of 2.16(:)1, distribution of age varied from 28 to 91 years. Majority of the men were in the age group of more than 60 years (45.37%) and majority of females were of 51-60 years (44%). Nearly 7.6% patients had a positive family history. Dietary history of intake salted, fermented fish was present in 67.7% of patients, whereas history of consumption of smoked meat was found in 77.8% of patients. Only 27.8% of patients in our study had history of regular consumption of fresh fruits. About 35.4% of the patients had poor drinking water source. Nearly, 67.6% of males and 44% of females had smoking history. Combined consumption of alcohol and smoking was present in 33.5% of patients. Vague abdominal discomfort was the most common presenting symptom in 61.4% of patients. The most common site of gastric cancer in our study was antrum (50.6%) followed by cardia (17.1%). The most common histological type was adenocarcinoma (95.6%). Most of our patients presented in locally advanced stage (62.7%).

CONCLUSIONS

Our analysis suggests that poor dietary habits such as smoked mead, dried fish and excessive use of tobacco are associated with high occurrence of gastric cancer in this part of the India. Increasing the awareness regarding the aetiology and varied clinical presentation among general population and health providers is needed for prevention and early detection.

Characteristics and prognosis of gastric cancer in young patients

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.

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

BACKGROUND AND OBJECTIVES

Gastric adenocarcinoma (GC) occurs frequently in the sixth decade of life and is uncommon in patients aged 40 years or younger. The aims of this study were to define the clinicopathological features and elucidate the prognostic factors of GC in the young.

METHODS

Between 1998 and 2006, 1,815 GC patients undergoing resection were enrolled in a prospective database. The findings for 115(6.0%) patients aged 40 years or younger were compared with those of 1,009 patients between 56 and 75 years old.

RESULTS

The group of young patients with GC included significantly more women than the group of old patients (60.0% vs. 37.0%, respectively); young patients also had more T4 lesions (73.9% vs. 61.6%), undifferentiated tumors (85.2% vs. 55.1%), severe desmoplasia (41.4%vs. 12.2%), Lauren’s diffuse-type cancers (55.6% vs. 27.7%), and perineural invasion (69.1% vs. 46.1%). Survival rates in younger patients at 3, 5, and 10 years after resection were 56.8%, 52.0%, and 42.1%, respectively, similar to those in older patients (P ¼ 0.411). Unfavorable independent prognostic factors of GC in the young were degree of nodal involvement (N3 vs. N0; P ¼ 0.001), advanced T status (T3–4 vs.T1–2; P ¼ 0.015), tumor size (>4 vs. ≤4 cm; P ¼ 0.019), and status of resection margins (positive vs. negative; P ¼ 0.044).

CONCLUSIONS

GC tends to exhibit more aggressive tumor behavior in young patients than in old patients; however, the surgical survival of young and old patients was similar. Advanced nodal involvement (N3) is the most important independent prognostic factor in the young.

Clinicopathological features and surgical treatment of gastric cancer in South Korea: the results of 2009 nationwide survey on surgically treated gastric cancer patients

Purpose

In an effort to examine the clinicopathological characteristics of GC and the status of its surgical treatment, the Korean Gastric Cancer Association (KGCA) conducted a nationwide survey targeting surgically-treated gastric cancer patients in 2009.

Materials and Methods

A standardized electrical case report was sent to every member institution of the KGCA via E-mail with detailed instructions regarding the survey data. Completed data forms were retrieved from each institution and analyzed by the KGCA information committee.

Results

Data on 14,658 patients was collected from 59 institutions. The mean patient age was 59.2±11.9 years with a male to female ratio of 2.05 : 1. Lower third cancer (56.0%) was the most common among all gastric cancers. The histological type revealed poorly differentiated adenocarcinoma (34.1%) to be the most common, and the Lauren classification revealed the intestinal type (50.0%) to be the most prevalent. Curative surgery was performed in 92.4% of patients with laparoscopic surgery in 25.8% of patients. A Billroth I reconstruction was performed most frequently after a distal gastrectomy (63.4% of distal gastrectomy). T1 cancers accounted for 57.6% of all cases, and 62.6% of patients showed no lymph node metastasis. Compared to previous reports, it was found that patients are becoming older, laparoscopic surgery is being performed increasingly, and the proportion of T1 cancer is increasing with time.

Conclusions

This survey presented the clinicopathological characteristics and current status of the surgical treatment of gastric cancer in Korea. This survey is expected aid research studies as well as planning and evaluation programs targeting cancer control.

Gastric adenocarcinoma in young patients: a population-based appraisal

BACKGROUND

Although international studies of young gastric cancer patients have mainly reported favorable survival outcomes compared with older patients, US-based experiences have shown a wider spectrum of outcomes. We examined the impact of young age (under 45 years) on the presentation and survival outcomes of gastric adenocarcinoma.

METHODS

A total of 33,236 patients with gastric adenocarcinoma were identified within the 1988-2006 Surveillance, Epidemiology, and End Results (SEER) registry. Multivariate regression analysis of relative survival was performed to adjust for covariate effects using generalized linear models.

RESULTS

Young patients were more likely than older patients to have advanced nodal and distant metastatic disease at presentation (P < 0.001 for both). Unadjusted relative survival analysis demonstrated younger patients to have favorable stage-stratified survival when compared with middle-aged and older patients. These findings persisted after adjusting for covariates. After stratifying for receipt of cancer-directed surgery, younger age was associated with more favorable stage-stratified relative survival.

CONCLUSIONS

This is the largest US population-based study of age-related gastric cancer outcomes. Although young patients with gastric cancer present with more advanced disease, their adjusted stage-stratified relative survival is more favorable than that of older patients. This study supports a stage-dependent treatment approach in younger populations.

Low frequency of HER2 amplification and overexpression in early onset gastric cancer

Background

The recent ToGA trial results indicated that trastuzumab is a new, effective, and well-tolerated treatment for HER2-positive gastric cancer (GC). Although GC mainly affects older patients, fewer than 10% of GC patients are considered early-onset (EOGC) (presenting at the age of 45 years or younger). These EOGC show different clinicopathological and molecular profiles compared to late onset GC suggesting that they represent a separate entity within gastric carcinogenesis. In light of potential trastuzumab benefit, subpopulations of GC such as EOGC (versus late onset) should be evaluated for their frequency of amplification and overexpression using currently available techniques.

Methods

Tissue microarray (TMA) blocks of 108 early onset GC and 91 late onset GC were stained by immunohistochemistry (IHC, Hercep test, DAKO) and chromogenic in situ hybridization (CISH, SPoT-Light, Invitrogen).

Results

Overall, we found only 5% HER2 high level amplification and 3% HER2 3+ overexpression (6/199). In addition, 8 patients (4%) showed a low level CISH amplification and 9 patients (4.5%) showed a 2+ IHC score. IHC and CISH showed 92% concordance and CISH showed less heterogeneity than IHC. In 2/199 cases (1%), IHC showed clinically relevant heterogeneity between TMA cores, but all cases with focal IHC 3+ expression were uniformly CISH high level amplified. Early onset GCs showed a significantly lower frequency of HER2 amplification (2%) and overexpression (0%) than late onset GCs (8% and 7% respectively) (p = 0.085 and p = 0.008 respectively). Proximal GC had more HER2 amplification (9% versus 3%) and overexpression (7% versus 2%) than distal tumours although this difference was not significant (p = 0.181 and p = 0.182 respectively). HER2 CISH showed more high level amplification in the intestinal type (7%, 16% if low-level included) compared to the mixed (5%, 5% if low-level included) and diffuse type (3%, 4% if low-level included) GCs (p = 0.029). A similar association was seen for HER2 IHC and histologic type (p = 0.008). Logistic regression indicated a significant association between HER2 expression and age, which remained significant when adjusted for both location and histological type.

Conclusions

Even focal HER2 overexpression in GC points to uniform HER2 amplification by CISH. We show for the first time that early onset GC has a lower frequency of HER2 amplification and overexpression than late onset GC, and confirm that intestinal type GC shows the highest rate of HER2 amplification and overexpression.

Retrospective analysis of prognostic outcome of gastric cancer in young patients

BACKGROUND

It has been suggested that gastric cancer in young patients has a worse prognosis than in older patients, but this is controversial. This retrospective investigation was undertaken to understand the clinicopathological features and identify the prognostic factors of gastric cancer in young patients.

METHODS

Patients included in this study were those treated and followed up for gastric cancer from 1989 to 2005. Operative records, clinical, pathological, and follow-up data were reviewed. The critical age cut-off value for obtaining distinctive prognoses was 34 years.

RESULTS

Of 1730 gastric cancer patients whose records were reviewed, 27 were less than 34 years old (YGC group). The YGC group contained significantly higher percentages of females, stage IV, macroscopic type 4 tumors, poorly differentiated histology, peritoneal dissemination, and epigastric pain symptoms than the gastric cancer group aged 34 years or more (OGC group). Survival in the YGC group was significantly worse than in the OGC group (p = 0.0363). Ten-year survival was 68.5% in the YGC group and 81.8% in the OGC group. Survival in the YGC group was poorer for the stage IV patients, compared with OGC patients, especially for the stage IV patients with peritoneal dissemination and without liver metastases (H0P1 patients) (p = 0.049).

CONCLUSIONS

Age in gastric cancer affects the prognosis, which in gastric cancer patients less than 34 years old was significantly poorer than for older patients, because of the high incidence of stage IV cancer with peritoneal dissemination in gastric cancer patients less than 34 years old.

Clinicopathological profile and long-term outcome in young adults with gastric cancer: multicenter evaluation of 214 patients

BACKGROUND AND AIMS

Gastric cancer (GC) is usually diagnosed in the sixth and seventh decade of life, although it may also be found in younger patients. The aim of this study was to analyse the potential differences in demographic and clinicopathological factors between the younger (40 years of age and less) and older (above 40 years) population of GC.

MATERIALS AND METHODS

An electronic database covering all gastric cancer patients treated between 1977 and 1998 at eight university surgical centres was reviewed.

RESULTS

Of 3,431 patients treated, 214 (6.2%) were 40 years of age or younger. No differences in tumour staging or location could be identified, but the diffuse type lesions were more common in the younger patients (52.6 vs 29.8%). No differences were found in morbidity and mortality rates, except a higher incidence of cardiopulmonary complications in older patients undergoing stomach resection (6.6 vs 12.3%). Median survival of patients after gastrectomy was 24.7 months (95% confidence interval [CI] 22.7-26.6) and was insignificantly longer in younger (30.8 months, 95%CI 21.0-40.5) than older (24.1 months, 95%CI 22.1-26.1) patients (P = 0.056). Median survival for unresectable cases was 5.4 months (95%CI 5.1-5.7) and was comparable in the younger (median 5.5 months, 95%CI 5.2-5.8) and older (median 4.4 months, 95%CI 3.7-5.1) groups.

CONCLUSION

GC in young adults demonstrates only minor deviations from the general population with a similar long-term outcome.

Decisions for extent of gastric surgery in gastric cancer patients: younger patients require more attention than the elderly

BACKGROUND AND OBJECTIVES

There is a prevailing belief that young patients with gastric adenocarcinomas have a more aggressive disease.

METHODS

We reviewed the prospectively collected database of 753 gastric adenocarcinomas patients who had undergone curative gastrectomy. Clinicopathological factors and the survival rates for each pathological TNM stage were compared between patients younger than 40 years of age and the others.

RESULTS

Fifty-four (9.8%) patients were younger than 40 years of age. The overall accuracy of the intra-operative stage was 62.5%; 54.0% in the young patients and 63.5% in older patients (P = 0.006). Intraoperative under-staging was more commonly seen in the younger patients when compared to the older patients. These trends were more prominent in patients with surgical stage I disease. Age proved to be an independent risk factor influencing the accuracy of intraoperative staging using a logistic regression analysis. There was no difference in overall 3-year survival rate between the two age groups for each pathological TNM stage.

CONCLUSIONS

The present study showed that intra-operative under-staging was more common in young patients with gastric cancer, especially with stage I disease. This finding raises the concern for inaccurate diagnosis and surgical under treatment in younger patients with stage I gastric cancer.

Clinicopathological features and prognosis of gastric cancer in young European adults

Background

The aims of this study were to define the clinicopathological features and prognosis of gastric cancer in young European adults.

Methods

Between 1990 and 2004, 603 patients with gastric cancer were enrolled in a prospective database. The findings for 51 (8·5 per cent) patients aged 45 years or less were compared with those of 457 aged between 46 and 75 years.

Results

In the younger group there were significantly more women (57 versus 36·3 per cent; P = 0·004), Laurén diffuse-type carcinomas (73 versus 42·7 per cent; P &lt; 0·001), N2–3 lymph node metastases (59 versus 38·9 per cent; P = 0·005), stage IV disease (49 versus 35·7 per cent; P = 0·085) and resections that were non-curative (36 versus 18·5 per cent; P = 0·007) than in the older patients. Actuarial survival rates in younger patients at 5 and 10 years after resection were 40 and 32 per cent respectively, similar to those in older patients (P = 0·540). Unfavourable prognostic factors associated with poor 5-year survival were the degree of gastric wall invasion (T3–4 versus T1–2; P &lt; 0·001), lymph node invasion (positive versus negative; P &lt; 0·001), disease stage (III–IV versus I–II; P &lt; 0·001) and curability of resection (non-curative versus curative; P &lt; 0·001).

Conclusion

Gastric cancer in young adults tends to be more advanced; however, when matched for stage, the prognosis does not differ from that of older patients.

Intramucosal gastric adenocarcinoma of poorly differentiated type in the young is characterized by Helicobacter pylori infection and antral lymphoid hyperplasia

The aim of this investigation was to clarify the histological characteristics of gastric cancer in the young. Twenty-three surgically resected specimens of young patients (under 30 years of age; young group) with intramucosal cancer of poorly differentiated type and 42 surgically resected specimens of elderly patients (more than 40 years of age; elderly group) with tumors of the identical depth and histological type were examined. The degree of gastritis and Helicobacter pylori (H. pylori) infection was evaluated according to the updated Sydney system. The incidence of H. pylori infection was significantly higher in the young group than in the elderly group (96 vs 36%, P<0.05). Within the background mucosa, antral chronic inflammatory infiltrates with lymphoid-follicle hyperplasia were more severe, and intestinal metaplasia was less frequent in the young group than in the elderly group. Glandular atrophy was not different between the two groups. Intramucosal gastric adenocarcinomas of poorly differentiated type in the young may be associated with H. pylori infection with antral chronic inflammation with lymphoid-follicle hyperplasia, regardless of the existence of intestinal metaplasia within the background gastric mucosa.

Predicting individual survival after gastric cancer resection: validation of a U.S.-derived nomogram at a single high-volume center in Europe

OBJECTIVE

Validation of a U.S.-derived nomogram for individual prediction of disease-specific gastric cancer survival at a European institution.

SUMMARY BACKGROUND DATA

One major issue of modern cancer treatment is the individualization of therapy. For gastric cancer, Kattan et al, at Memorial Sloan-Kettering Cancer Center, New York, NY, developed a nomogram, allowing to predict individual patient risk of tumor-related death after R0 resection from basic patient-related variables. The validity of the nomogram has not yet been shown in patients from other institutions. The accuracy of the nomogram when applied to patients after having undergone R0 gastric cancer resection at a European high-volume center was investigated.

METHODS

Clinical data from patients who underwent R0 gastric cancer resection at Klinikum rechts der Isar, Technical University of Munich, Germany and fitted the respective derivation criteria were used for external validation (n = 862). Nomogram predictions for 60- and 108-month disease-specific survival were calculated for each patient and compared with actual survival. The concordance index was used as an accuracy measure.

RESULTS

The bootstrap-corrected concordance index was 0.77 and was superior when compared with the predictive ability of International Union Against Cancer tumor stage (P < 0.008). Nomogram calibration was excellent for 60-month disease-specific survival. Nomogram predictions showed the trend to underestimate survival in stage II/III disease of the MRI patients.

CONCLUSIONS

The use of the nomogram created by Kattan et al is not only confined to the institution where it was created, but it can be adopted by other institutions with similar surgical strategies.

Clinicopathologic characteristics of gastric carcinoma in elderly patients: A comparison with young patients

AIM: To examine the clinicopathologic features of elderly patients with gastric carcinoma and to investigate the relationship between prognosis and age.

METHODS: We reviewed the hospital records of 2014 patients with gastric carcinoma retrospectively to compare the clinicopathologic findings in elderly (age >70 years) and young (age <36 years) patients during the period from 1986 to 2000 in a tertiary referral center in Gwangju, Korea. Overall survival was the main outcome measure.

RESULTS: Of the 2014 patients, 194 (9.6%) were in the elderly group and 137 (6.8%) were in the young group. The elderly and young patients had similar distributions with respect to depth of invasion, nodal involvement, hepatic metastasis, peritoneal dissemination, tumor stage at the initial diagnosis, and type of surgery. Synchronous multiple carcinomas were found in 14/194 (7.2%) of the elderly group and 4/137 (2.9%) of the young group (P<0.05). Using the Borrmann classification, type IV was more frequent in the young patients than in the elderly patients (P<0.05). Significantly more elderly patients had a well or moderately differentiated histology, and more young patients had a poorly differentiated histology and signet ring cell carcinoma (P<0.001). The 5-year survival rates of elderly and young patients did not differ statistically (52.8% vs 46.5%, P = 0.5290). Multivariate analysis showed that the histologic type, nodal involvement and operative curability were significant prognostic factors, and age itself was not an independent prognostic factor of survival for elderly gastric carcinoma patients.

CONCLUSION: Elderly patients with gastric carcinoma do not have a worse prognosis than young patients. The important prognostic factor is whether the patients undergo a curative resection.