Early-onset gastric cancer: A distinct clinical entity with a different prognosis?

22 Background: This study aimed to evaluate the early onset gastric cancer (EOGC), considered as gastric cancer in a patient younger than 45 years, as a distinct entity with a different prognosis. Methods: This study is related to 1,256 patients admitted with gastric or gastroesophageal junction carcinoma in our department between January 1988 and December 2008. There were 10.59% (133 cases) of EOGC in our series. The following clinical, pathological and staging parameters were studied: age, gender, tumor location, ressecability, type of resection surgery, type of resection, type of lymphadenectomy (Siewert and Japanese classifications), number of lymph nodes studied, tumor dimensions, macroscopic form, histological classification (Lauren and Ming), venous invasion, lymphatic permeation, perineural invasion, depth wall invasion (T), lymph node metastases (N) – TNM and Japanese classification and lymph node ratio – distance metastases (M) and stage. Results: Significant differences were observed in the type of resection surgery (p<0.001) and type of lymphadenectomy (p=0.008), with more radical surgery performed in EOGC patients. Some tumor characteristics also showed significant differences: tumor dimensions (p=0.004), with EOGC usually smaller; diffuse type according to Lauren's classification (p<0.001); infiltrative type according to Ming's classification (p=0.001); less venous invasion (p=0.005); less lymphatic permeation (p=0.029). There were no significant differences in the staging parameters. There were significant differences in the survival rate (p<0.001), with 5-year survival rate of 44% in patients with EOGC compared with 31% in older patients. Cox-regression analysis revealed that age was an independent prognostic factor (HR 2,166, 1,133-4,139 CI 95%, p = 0.019), as well as depth wall invasion (T) and lymph node ratio. Conclusions: In this study, EOGC revealed to be a distinct clinical entity that presented differences in various clinico-pathological parameters. Despite EOGC presented more aggressive pathological characteristics, there was a better survival in this group, probably because the physical status of younger patients which allowed a more aggressive treatment. No significant financial relationships to disclose.