Young Age Increases Risk for Lymph Node Positivity in Gastric Cancer: A Chinese Multi-Institutional Database and Us Seer Database Study

Abstract

Background: The risk of lymph node positivity (LN ) in gastric cancer (GC) impacts therapeutic recommendations. The aim of this study was to quantify the effect of younger age on LN . Methods: Data from a Chinese multi-institutional database and the US SEER database on stage I to III resected GC were analyzed for the relationship between age and LN status. The association of age and LN status was examined with logistic regression separately for each T stage, adjusting for multiple covariates. Poisson regression was used to evaluate age and number of LN . Findings: 4,905 and 14,877 patients were identified in the China and SEER datasets respectively. 479 (9.8%) patients were under age 40 years, with 768 (15.7%) between age 40 and 49 years in China dataset, and 416 (2.8%) patients were under age 40 years, with 1176 (7.9%) between age 40 and 49 years in SEER dataset. Both datasets exhibited significantly proportional decreases of N3a and N3b LN with age increasing. Patients younger than age 40 years were more likely to show LN compared with the reference age 60 to 69 years. The youngest patients had the highest ORs of N1, N2, N3a, and N3b vs N0 LN within T4 stage of China dataset and T3 stage of SEER dataset, the values of ORs decreased with increasing age. Young age was a predictor of an increased number of LNs positive for each T stage. Interpretation: In the two large datasets, young age at diagnosis is associated with an increased risk of LN . Funding: This work was supported by grants from: National Natural Science Foundation of China 81672446, 81370575, 81570593. Natural Science Foundation of Guangdong Province, 2014A030313131. Science and Technology Planning Project of Guangzhou, 2014B020228003, 2014B030301041, 2015A030312013. Science and Technology Program of Guangzhou, 158100076, 201400000001-3. Public welfare in Health Industry, National Health and Family Planning Commission of China (201402015, 201502039). Key Clinical Specialty Discipline Construction Program. Declaration of Interest: The authors declare that they have no conflict of interest. Ethical Approval: This study was approved by the research ethics committees at the 3 participating centers, and the informed consent requirement was waved.