Gastric cancer in young patients under the age of 45 years old: A comparative study with older patients
Authors: S. Karrit, I. Belaid, F. Ezzairi, A. Bedioui, A. El Ghali, N. Bouzid, M. Ben Mabrouk, F. Bouzaiene, Y. Ben Cheikh, I. Chabchoub, M. Hochlaf, L. Ben Fatma, S. Ben Ahmed
Journal: Annals of Oncology (2018)

Introduction: Over the last decade the incidence rate of gastric cancer in young patients has a trend towards a gradual increase. This retrospective comparative study aims to identify clinico-pathological characteristics of young patients with gastric cancer and to analyse prognostic factors influencing their survival. Methods: Patients diagnosed with gastric cancer at our department between 2000 and 2017 were identified and divided into two groups: the group of the young patients who are under the age of 45 years old (A group) and the group of old patients who are over this age limit (B group). Results: A total of 115 patients were studied. 22 patients (19%) were younger than 45 years. Weight loss was frequent in both groups (54.5% in A group and 61% in B group). Preserved general status was more common in A group (85.8% had a 0-1 PS vs 69%, p = 0.1). Proximal tumors were respectively seen in 63.6% and 51.7% of cases. Linitis was more frequent in A group (20%, p = 0.3). Signet ring cell adenocarcinoma was more common in A group (81.3% versus 74.1%). Adenosquamous carcinomas and well differentiated tumors were only found in older patients (respectively 6.8% and 10.1%; p = 0.2, p = 0.8). Synchronous metastases were more frequent in young patients (50% vs 39.1%, p = 0.5). Young patients had more surgery than old ones (respectively 68.2% vs 61.4%, p = 0.5). Advanced stages after surgery were more common in A group: pT 3-4 stages (90.9% vs 63.2%; p = 0.6) andpN3 stage (41.7% vs 23.1%; p = 0.3). They also had a higher positive lymph node ratio (respectively 0.4 vs 0.33, p = 0.5). 73.9% of the patients received chemotherapy: DCF was the preferred neo adjuvant chemotherapy regimen in A group (50%) whereas it was FOLFOX in B group (37.5%). Complete radiological responses were only seen in older patients (11.1%; p = 0.3). Similar proportion of young and old patients received first and second lines palliative chemotherapy (respectively: 92.3% vs 92.1% and 25% vs 25.7%) but a higher proportion of young ones received a third line treatment (8.3% vs 2.9%; p = 0.4). LV5 FU2 Cisplatin was the most commonly used protocol in first line in the two groups (respectively 58.3% vs 57.1%). Higher proportion of radiologic progression was noted in older patients after first line palliative chemotherapy (55.5% vs 45.5%; p = 0.6) and after second line (85.7% vs 50%; p = 0.2). Younger age was not associated with significantly better PFS or OS: respectively in young patients 10 and 10.5 months versus in old ones 6.5 and 8 months (p = 0.6; p = 0.4). Some factors influenced OS and PFS specifically in younger patients: long time (>3months) to diagnosis (p = 0.04), low BMI (p = 0.005), proximal tumors (p = 0.04) with especially cardial ones (p = 0.03), stage pT4 (p = 0.008) and presence of bone metastases (p = 0.03). Conclusion: Young patient with gastric cancer seemed to have more aggressive tumors: more linitis, signet cell adenocarcinoma subtype, metastases at diagnosis, and advanced pTN stages. More aggressive treatments should be recommended for this group of patients.