Gastric Adenocarcinoma in Young Patients: a Population-Based Appraisal (original) (raw)

Abstract

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.

Access this article

Log in via an institution

Subscribe and save

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Parkin DM, Pisani P, Ferlay J. Global cancer statistics. CA Cancer J Clin. 1999;49(1):33–64, 1.
    Article PubMed CAS Google Scholar
  2. Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin. 2005;55(1):10–30.
    Article PubMed Google Scholar
  3. Roder DM. The epidemiology of gastric cancer. Gastric Cancer. 2002;5(Suppl 1):5–11.
    Article PubMed Google Scholar
  4. WHO. Facts about cancer; 2007.
  5. Choi JH, Chung HC, Yoo NC, et al. Gastric cancer in young patients who underwent curative resection. Comparative study with older patients. Am J Clin Oncol. 1996;19(1):45–8.
    Article PubMed CAS Google Scholar
  6. Kitamura K, Yamaguchi T, Yamamoto K, et al. Clinicopathological analysis of gastric cancer in young adults. Hepatogastroenterology. 1996;43(11):1273–80.
    PubMed CAS Google Scholar
  7. Llanos O, Butte JM, Crovari F, Duarte I, Guzman S. Survival of young patients after gastrectomy for gastric cancer. World J Surg. 2006;30(1):17–20.
    Article PubMed Google Scholar
  8. Matley PJ, Dent DM, Madden MV, Price SK. Gastric carcinoma in young adults. Ann Surg. 1988;208(5):593–6.
    Article PubMed CAS Google Scholar
  9. Ramos-De la Medina A, Salgado-Nesme N, Torres-Villalobos G, Medina-Franco H. Clinicopathologic characteristics of gastric cancer in a young patient population. J Gastrointest Surg. 2004;8(3):240–4.
    Article PubMed Google Scholar
  10. Theuer CP, de Virgilio C, Keese G, et al. Gastric adenocarcinoma in patients 40 years of age or younger. Am J Surg. 1996;172(5):473–6;discussion 476–7.
    Article PubMed CAS Google Scholar
  11. Theuer CP, Kurosaki T, Taylor TH, Anton-Culver H. Unique features of gastric carcinoma in the young: a population-based analysis. Cancer. 1998; 83(1):25–33.
    Article PubMed CAS Google Scholar
  12. Park JC, Lee YC, Kim JH, et al. Clinicopathological aspects and prognostic value with respect to age: an analysis of 3,362 consecutive gastric cancer patients. J Surg Oncol. 2009;99(7):395–401.
    Article PubMed Google Scholar
  13. Santoro R, Carboni F, Lepiane P, Ettorre GM, Santoro E. Clinicopathological features and prognosis of gastric cancer in young European adults. Br J Surg. 2007;94(6):737–42.
    Article PubMed CAS Google Scholar
  14. Koea JB, Karpeh MS, Brennan MF. Gastric cancer in young patients: demographic, clinicopathological, and prognostic factors in 92 patients. Ann Surg Oncol. 2000;7(5):346–51.
    Article PubMed CAS Google Scholar
  15. Smith BR, Stabile BE. Extreme aggressiveness and lethality of gastric adenocarcinoma in the very young. Arch Surg. 2009;144(6):506–10.
    Article PubMed Google Scholar
  16. National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) program. Public Use Date (1973–2002), released April 2005. (www.seer.cancer.gov).
  17. Greene F, Page D, Fleming I. AJCC cancer staging manual. 6th ed. New York: Springer-Verlag; 2002.
    Google Scholar
  18. Hoel DG, Ron E, Carter R, Mabuchi K. Influence of death certificate errors on cancer mortality trends. J Natl Cancer Inst. 1993;85(13):1063–8.
    Article PubMed CAS Google Scholar
  19. Dickman PW, Sloggett A, Hills M, Hakulinen T. Regression models for relative survival. Stat Med. 2004;23(1):51–64.
    Article PubMed Google Scholar
  20. Kim DY, Ryu SY, Kim YJ, Kim SK. Clinicopathological characteristics of gastric carcinoma in young patients. Langenbecks Arch Surg. 2003;388(4):245–9.
    Article PubMed CAS Google Scholar
  21. Tso PL, Bringaze WL 3rd, Dauterive AH, Correa P, Cohn I Jr. Gastric carcinoma in the young. Cancer. 1987;59(7):1362–5.
    Article PubMed CAS Google Scholar
  22. Siewert JR, Holscher AH, Becker K, Gossner W. Cardia cancer: attempt at a therapeutically relevant classification. Chirurgie. 1987;58(1):25–32.
    CAS Google Scholar
  23. Al-Refaie WB, Parsons HM, Henderson WG, et al. Major cancer surgery in the elderly: results from the American College of Surgeons National Surgical Quality Improvement Program. Ann Surg. 2010;251(2):311–8.
    Article PubMed Google Scholar

Download references

Acknowledgment

We thank Maude Veech and Diane Hackett for their assistance with editing this manuscript.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Minnesota and Minneapolis Veteran Affairs Medical Center, Minneapolis, MN, USA
    Waddah B. Al-Refaie MD, FACS
  2. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
    Chung-Yuan Hu MPH, Peter W. T. Pisters FACS & George J. Chang FACS

Authors

  1. Waddah B. Al-Refaie MD, FACS
    You can also search for this author inPubMed Google Scholar
  2. Chung-Yuan Hu MPH
    You can also search for this author inPubMed Google Scholar
  3. Peter W. T. Pisters FACS
    You can also search for this author inPubMed Google Scholar
  4. George J. Chang FACS
    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence toWaddah B. Al-Refaie MD, FACS.

Rights and permissions

About this article

Cite this article

Al-Refaie, W.B., Hu, CY., Pisters, P.W.T. et al. Gastric Adenocarcinoma in Young Patients: a Population-Based Appraisal.Ann Surg Oncol 18, 2800–2807 (2011). https://doi.org/10.1245/s10434-011-1647-x

Download citation

Keywords