| Purpose:To analyze the clinicopathological characteristics and prognostic factors of early onset gastric cancer patients(EOGCs)to provide individualized treatment.Methods:Retrospectively reviewed 142 patients with gastric cancer aged 20-34 between May 2003 and April 2018 in Sir Run Run Shaw Hospital as group A(Chinese population),and 957 patients with gastric cancer aged 20-34 between January 2004 and December 2015 in The Surveillance,Epidemiology,and End Results(SEER)database as group B(American population).The gender,age,tumor size,tumor location,histological type,depth of invasion,lymph node metastasis,distant metastasis,TNM stage,disease-free survival(DFS)and overall survival(OS)were compared between the two groups.The independent prognostic factors of early onset gastric cancer patients(EOGCs)were analyzed by multivariate COX regression.Results:1.Early onset gastric cancer patients accounted for 2.1%of total gastric cancer population in group A,and 1.9%of total gastric cancer population in group B.2.The median age of patients in group A and group B were both 31.The ratio of male to female in group A was 1:1.5,which was 1:1 in group B.In group A,59.9%of patients' BMI ranged from 18.5-23.9 kg/m2,26.8%of patients' BMI<18.5 kg/m2,and 9.1%of patients' BMI>23.9 kg/m2.Drinking patients accounted for 15.5%in group A.Smoking patients accounted for 17.6%in group A.Patients with helicobacter pylori infection accounted for 21.8%.Patients with positive family history of malignant tumors accounted for 4.2%in group A.Alcohol consumption,smoking status,helicobacter pylori infection status,family history of malignant tumors and BMI of patients in group B were not recorded.3.The initial symptoms of patients in group A mainly included abdominal pain(58.45%),bloating(20.42%),melena(19.72%),vomiting(16.9%),nausea(16.2%),and weight loss(15.5%).The average consulting time was 3.8 months.The initial symptoms and consulting time of patients in group B were not recorded.4.EOGCs were dominated by poorly differentiated adenocarcinoma(58.5%)and pyloric antrum occupying(57.0%)in group A,while EOGCs were dominated by signet ring cell carcinoma(41.1%)and corpus occupying(36.8%)in group B.The average tumor diameter in group B was significantly larger than that in group A(4.8cm vs 4.2cm,P<0.05).The average lymph node metastases rate in group B was significantly higher than that in group A(32%vs 21%,P<0.05).The R0 resection rate was 90.7%,the Her2 positive rate was 1.4%,and the vascular or nerve invasion rate was 29.9%in group A.The margin status,expression of Her2,and vascular or nerve invasion status of patients in group B were not recorded.5.BMI(HR=4.680,P=0.002)and vascular or nerve invasion status(HR=5.547,P=0.001)were independent prognostic factors for DFS of patients in group A.6.BMI(HR=7.015,P=0.001),vascular or nerve invasion status(HR=9.642,P<0.001)and M stage(HR=6.552,P=0.001)were independent prognostic factors for OS of patients in group A.7.Surgical therapy(HR=2.387,P<0.001),histopathological type(signet ring cell carcinoma,HR=6.330,P<0.001;poorly differentiated adenocarcinoma,HR=5.209,P<0.001),T stage(HR=1.538,P=0.001)and M stage(HR=3.152,P<0.001)were independent prognostic factors for OS of patients in group B.8.Compared with the OS of patients in group B,the OS of patients in group A was significantly prolonged(P<0.05).The OS of patients under surgical therapy in group A was significantly prolonged than that of patients under surgical therapy in group B(P<0.05).The OS of patients without surgical therapy wasn't statistically significant between group A and group B(P>0.05).The OS of patients in stage II-III in group A was significantly prolonged than that of patients in stage II-III in group B(P<0.05).The OS of patients in stage ? and stage ? wasn't statistically significant between group A and group B(P>0.05).9.Compared with group A,the proportion of stage ? patients was significantly higher in group B(55.7%vs 31.7%,P<0.05).Peritoneum metastasis(82.2%in group A,34.7%in group B)was most common in stage IV patients,followed by ovarian metastasis(38.9%in group A),liver metastasis(17.8%in group A,11.6%in group B)and bone metastasis(11.1%in group A,and 8.3%in group B).The OS of stage IV patients benefited from palliative surgery both in group A(HR=2.407,P=0.017)and group B(HR=1.476,P=0.001).The OS of stage IV patients benefited from first-line chemotherapy in group A(HR=5.690,P<0.001).Chemotherapy status of patients in group B was not recorded specifically.Conclusion:1.Young adults,especially female,who showed non-specific gastrointestinal symptoms,such as abdominal pain,bloating,melena,should be aware of gastric cancer.2.In different populations,the clinicopathological characteristics of EOGCs were quite different.Comparing with Chinese EOGCs,American EOGCs had higher degree of malignancy in pathology and biological behaviors.3.BMI and vascular or nerve invasion status were independent prognostic factors for DFS of Chinese EOGCs.4.BMI,vascular or nerve invasion status and M stage were independent prognostic factors for OS of Chinese EOGCs.5.Surgical therapy,histopathological type,T stage and M stage were independent prognostic factors for OS of American EOGCs.6.In different populations,the prognosis of EOGCs were quite different.Comparing with American EOGCs,Chinese EOGCs had better prognosis.Postoperative EOGCs and stage II-III EOGCs had better prognosis in Chinese population than those in American population.7.Peritoneum metastasis was most common in stage IV EOGCs.Surgical therapy and first-line chemotherapy could improve the prognosis of stage ? EOGCs. |
PDF Full Text Request