Gastric adenocarcinoma in young patients: A population-based appraisal

Background: Although international studies of young gastric cancer patients have mainly reported favorable survival outcomes compared with older patients, US-based experiences have shown a wider spectrum of outcomes. We examined the impact of young age (under 45 years) on the presentation and survival outcomes of gastric adenocarcinoma. Methods: A total of 33,236 patients with gastric adenocarcinoma were identified within the 1988-2006 Surveillance, Epidemiology, and End Results (SEER) registry. Multivariate regression analysis of relative survival was performed to adjust for covariate effects using generalized linear models. Results: Young patients were more likely than older patients to have advanced nodal and distant metastatic disease at presentation (P < 0.001 for both). Unadjusted relative survival analysis demonstrated younger patients to have favorable stage-stratified survival when compared with middle-aged and older patients. These findings persisted after adjusting for covariates. After stratifying for receipt of cancer-directed surgery, younger age was associated with more favorable stage-stratified relative survival. Conclusions: This is the largest US population-based study of age-related gastric cancer outcomes. Although young patients with gastric cancer present with more advanced disease, their adjusted stage-stratified relative survival is more favorable than that of older patients. This study supports a stage-dependent treatment approach in younger populations.