| BackgroundGastric cancer is the fourth most common cancer in the world,and the second most common cancer in China.China's epidemiological survey shows that the incidence of gastric cancer and mortality at different ages are very different.So it is necessary to explore the clinicopathological features and the prognosis of gastric cancer at different ages,which could provide the basis to the development of the treatment in different aged patient.Compared with middle-aged patients,the proportion of female patients is significantly higher among young patients.Furthermore,a significantly higher frequency of histologically undifferentiated tumor types and N3 status are more common in young patients.The prognosis in young gastric cancer patients has been reported to comparable to that in middle-aged patients.On the other hand,Saito et al.reported that prognosis in young gastric cancer patients is worse than that in middle-aged patients.Data on the clinicopathological features and prognosis of elderly gastric cancer patients are controversial.It was indicated that poorly differentiated tumors were more common in elderly patients.However,some research indicated that younger patients exhibited a predominance of poorly differentiated tumor.Furthermore,it was reported that the prognosis of gastric cancer in the elderly was worse than in non-elderly patients because of the aggressive biological behavior and poorly differentiated histology of the tumor.However,Zeeneldin et al reported that the prognosis in elderly patients is equivalent to or better than that in non-elderly patients.Moreover,little is known about the clinicopathological features and prognosis of gastric cancer in different aged Chinese patients.Objective 1.To explore the clinicopathological features and prognostic characteristics of young patients with gastric cancer,and to explore the differences in clinicopathological features and prognosis of young and middle-aged gastric cancer patients.2.To explore the clinicopathological features and prognostic characteristics of elderly patients with gastric cancer,and to explore the differences in clinicopathological features and prognosis of elderly and middle-aged patients with gastric cancer.Methods1.(1)From May 2008 to December 2014,a total of 5285 gastric cancer patients underwent treatment in our department.According to inclusion criteria,patients were divided into young,middle-aged and elderly patient.(2)To analyze the difference of clinicopathological features and prognosis of young and middle-aged gastric cancer patients,and explore the related factors which affect the prognosis of young gastric cancer patients2.(1)Clinicopathological date of 815 elderly gastric cancer patients who underwent radical gastrectomy in our department from May 2008 to December 2014 were retrospectively analyzed.(2)To analyze the difference of clinicopathological features and prognosis of eldly and middle-aged gastric cancer patients after radical resection.Results1.(1)According to our inclusion and exclusion criteria,198 patients who were 40 aged or under were defined as young gastric cancer and 1096 patients who were aged 55-64 years were defined as middle-aged gastric cancer.(2)Compared with middle-aged patients,the proportion of females,lower third tumors,tumor size less than 5 cm,poorly differentiated tumors and T1 tumors were significantly higher in young patients(all P < 0.05).The proportions of comorbidity,upper third tumors,well and moderately differentiated tumors,T4 tumors,and positive carcinoembryonic antigen(CEA),alpha fetoprotein(AFP)and carbohydrate antigen(CA)19–9 were significantly lower in young patients(all P< 0.05).The distributions of N status and CA125 were comparable between young and middle-aged patients(all P> 0.05).The five-year overall survival rates were comparable between young patients and middle-aged patients(62.8 vs 54.7 %,P = 0.307),age was not a risk factor for prognosis of these patients.The tumor location,T status,N status and CA125 were independent predictors of prognosis in young patients.The overall survival of patients with tumors located in the upper or middle third was significantly lower than for those located in the lower third(60.8 vs 50.6 vs 68.4 %,P = 0.016).The overall survival of CA125-positive patients was significantly lower than CA125-negative patients(49.0 vs 64.4 %,P = 0.001).2.(1)The proportion of dysphagia was significantly higher in elderly patients than that in middle-aged patients(P=0.002),while the proportion of abdominal pain and heartburn were significantly lower in elderly patients than that in middle-aged patients(P<0.001,P=0.038,respectively).The proportion of patients with CA19-9 was significantly higher in elderly patients than that in middle-aged patients(P=0.009).(2)There was no significant difference in clinicopathological features between elderly and middle-aged patients with D2 gastrectomy(all P>0.05).Age,tumor size,histological type,tumor depth,lymph node metastasis,CEA,AFP,CA19-9 and CA125 were independent risk factors for the prognosis of gastric cancer patients in univariate and multivariate analyses.Overall survival in elderly patients was significantly reduced compared with middle-aged patients(P=0.001),especially in patients with tumor size larger than 5 cm(P=0.002),poorly differentiated tumor(P<0.000),stage III tumor(P=0.002),or normal levels of CEA(P=0.009),AFP(P=0.002),CA19-9(P=0.002),and CA125(P=0.004).Conclusions1.The clinicopathological features were significantly different between young and middle-aged patients.The prognosis of gastric cancer in young patients was equivalent to that of middle-aged patients,age was not a risk factor for prognosis of these patients.Tumor location,T status,N status and CA125 were independent risk factors for prognosis in young patients.2.The clinicopathological features of elderly patients were equivalent to those of middle-aged patients.The prognosis for elderly gastric cancer patients was significantly worse than for middle-aged patients,especially in patients with tumor size larger than 5 cm,poorly differentiated tumor,stage III tumor,or normal levels of serum tumor markers. |
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