Unique features of gastric carcinoma in the young: a population-based analysis.

Abstract

It is suspected that young patients with adenocarcinoma have a more aggressive form of disease and therefore a poorer prognosis than older patients. A retrospective cohort study used the population-based tumor registries of Orange, San Diego, and Imperial Counties. Cases (patients age < or =40 years with gastric carcinoma) were compared with controls (patients age >40 years with gastric carcinoma). The overall, age-adjusted incidence rate of gastric carcinoma was 10.2/100,000. Approximately 5.5% of 3,020 cases occurred in patients age <41 years. Young patients (especially whites and Latinos) were more likely to have distant metastases [45% versus 34%; odds ratio (OR)=2.6; 95% confidence interval (CI), 1.4-4.8; P < 0.001]. The histology of young patients (especially Latinos and Asians) was more likely to be signet ring cell (28% versus 15%; OR=2.3; 95% CI, 1.6-3.3; P < 0.001), and the grade of young patients (especially whites and Latinos) was more likely to be Grade 3 or 4 (according to the World Health Organization International Classification of Diseases for Oncology; 68% versus 56%; OR=2.1; 95% CI, 1.4-3.3; P < 0.001). The tumors of young patients (especially Asians) were less likely to be of the gastroesophageal junction (16% versus 27%; OR=0.47; 95% CI, 0.31-0.72; P < 0.001) and of the antrum (17% versus 22%; OR=0.62; 95% CI, 0.41-0.95; P=0.03) than the gastric body. Younger patients were more likely to receive chemotherapy (50% versus 28%; OR=2.7; 95% CI, 1.9-3.7; P < 0.001). Only patients age >70 years had an independent increased risk of dying from all causes in comparison with young patients (relative risk 1.46; P=0.01). Young gastric carcinoma patients have adverse clinical and pathologic features in comparison with older patients. In this study, young age was not found to be an independent predictor of overall survival.