Abstract
17 Background: Recent foreign publications have demonstrated increasing frequencies of gastric cancer in younger patients with differing biology and outcomes. This study will be the largest of gastric adenocarcinoma (GA) in young adults and aims to examine disparities and the impact of age on overall survival (OS). Methods: All patients diagnosed with primary GA from 2004-2013 in the National Cancer Data Base (NCDB) were reviewed for patient demographics, tumor characteristics, and treatment. Patients were grouped by age (AYA < 40, adult ≥ 40) and appropriate statistical analyses performed. Results: Of 49,278 patients, 1517 (3%) were < 40 years old. Compared to older adults, AYAs were more commonly female, represented an ethnic minority, and had more markers of socioeconomic disadvantage (SES) (all p < 0.001). They presented with higher grade tumors, higher tumor and nodal staging, and more metastatic disease at diagnosis (all p < 0.001). AYAs also more commonly received adjuvant radiation and/or chemotherapy (all p < 0.001). Five-year OS in AYAs was 32.9% vs 29.4% for older adults (p < 0.001). After controlling for competing factors, higher tumor grade (HR 1.61, CI 1.32-1.97), distant metastases (HR 2.22, CI 1.84-2.68), and increasing tumor (HR 2.69-5.44) and nodal stage (HR 1.84-2.35) independently decreased OS in AYAs whereas Hispanic (HR 0.78, CI 0.65-0.93) or Asian ethnicity (HR 0.72, CI 0.56-0.93) and receipt of adjuvant chemotherapy improved OS (HR 0.62, CI 0.52-0.75). Similar results were seen in older adults except that all markers of low SES decreased OS also. Age < 40 had an independent effect on OS only for early stage (stage I/II) disease, resulting in a 19% survival advantage compared to older adults (HR 0.81, CI 0.71-0.93). Conclusions: Young patients with GA are more ethnically diverse and SES disadvantaged compared to older adults, with disparities effecting OS more in older patients. When diagnosed at an early stage, young age independently improves OS, emphasizing the importance of early diagnosis especially in this age group. Further research is needed to address whether national screening strategies could improve survival for selected young patients.
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