OGC P42 Presentation, Management and Outcomes in Young Patients Diagnosed with Gastric Cancer

Abstract

Abstract Background Gastric cancer poses a significant global health challenge, mainly affecting older individuals with well-established risk factors. However, outcomes in young patients have been perceived as poorer due to late diagnosis and more aggressive disease subtype. There are also a small sub-set of younger patients in which gastric cancer is genetically inherited. This comprehensive retrospective cohort study aimed to evaluate the patient characteristics, treatment modalities, and survival outcomes of young patients diagnosed with gastric cancer, to provide valuable insights into optimal therapeutic strategies. Methods A retrospective analysis was conducted using electronic medical records from a regional oesophago-gastric cancer service serving 3.5 million people across the North West of England, encompassing a 5-year period between January 2018 and December 2022 inclusive. Young patients were defined as being 50 or younger (eligible for genetic testing) at the time of diagnosis of gastric cancer. Clinical and pathological data, including tumour characteristics, treatment approaches, and survival outcomes, were collected. Survival analysis was performed utilising Kaplan-Meier estimates, and survival rates following gastrectomy were compared to publicly available outcomes. Results 60/956 (6.3%) patients were aged 50 or below at the time of diagnosis. Mean age was 42.1 (range = 28-50); 48% were male. Stages III and IV of disease were observed in 27% and 57% of patients respectively. Poorly differentiated disease was observed in 53%, with HER-2 positivity in 13%. Distal gastric cancer represented 56% of cases and proximal cancer 27%. Initial treatment intent was curative in 43%. 1-year and 3-year overall survival was 51% and 33. 3-year overall survival was 92% for 20 patients who received gastrectomy versus 60% in all patients reported by NOGCA. Conclusions This study suggests that young patients with gastric cancer present with significantly advanced disease. Despite this, young patients show similar medium- and long-term survival rates. Well selected young patients can be offered treatment with curative intent with good medium- to long-term outcomes. Future research should focus on understanding the underlying mechanisms in this group, exploring novel therapeutic strategies, including the role of genetic testing, as well as validating these finding in larger and more diverse patient populations.