Guan Wen-Long, Yuan Lu-Ping, Yan Xiang-Lei, Yang Da-Jun, Qiu Miao-Zhen
Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Experimental Research, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
J Cancer. 2019 Jan 1;10(2):472-478. doi: 10.7150/jca.27517. eCollection 2019.
Several studies have reported controversial results about prognosis of gastric cancer in young age patients. The difference may partially result from variable definitions of young age. The aim of this study was to find out the relation between age and prognosis of gastric cancer patients, and to analyze the clinicopathological features and prognostic factors in young gastric cancer patients. Data queried for this analysis included GC patients from the Surveillance, Epidemiology, and End Results Program database from 1973 to 2014. Gastric cancer patients (N=79,505) diagnosed with an age≥18 were included. By combining patients with similar prognosis, we figured out 3 cutoff values of age, 35 years old, 65 years old and 75 years old. We divided patients into 4 groups: young age patients: 18-34 years; middle-age patients: 35-64 years; elderly patients: 65-74 years; extremely elderly patients: >74 years. GC patients from Sun Yat-sen University Cancer Center (SYSUCC) were used as external validation data. The clinicopathological features of young age gastric cancer patients included: poor-differentiated, diffuse type of cancer, and advanced stage at diagnosis. The median survival of patients <35 years old was significantly lower than middle-age patients (35-64 years) and elderly patients (65-74 years) (12 months vs. 15 and 16 months, respectively, both p <0.001). Location of tumor, ethnicity, tumor size, surgery and TNM stage were independent prognostic factors by multivariate analysis in young patients. The poor prognosis for young patients remained valid in the SYSUCC database. Our results demonstrated that gastric cancer patients <35 years old had an extremely poor prognosis. Early detection of gastric cancer is of paramount importance in young age people.
多项研究报告了关于年轻胃癌患者预后的有争议结果。这种差异可能部分源于对年轻的不同定义。本研究的目的是找出胃癌患者年龄与预后之间的关系，并分析年轻胃癌患者的临床病理特征和预后因素。本次分析查询的数据包括1973年至2014年监测、流行病学和最终结果计划数据库中的胃癌患者。纳入了年龄≥18岁的胃癌患者（N = 79505）。通过合并预后相似的患者，我们确定了3个年龄临界值，即35岁、65岁和75岁。我们将患者分为4组：年轻患者：18 - 34岁；中年患者：35 - 64岁；老年患者：65 - 74岁；极高龄患者：>74岁。来自中山大学肿瘤防治中心（SYSUCC）的胃癌患者用作外部验证数据。年轻胃癌患者的临床病理特征包括：低分化、弥漫型癌症以及诊断时处于晚期。<35岁患者的中位生存期显著低于中年患者（35 - 64岁）和老年患者（65 - 74岁）（分别为12个月 vs. 15个月和16个月，p均<0.001）。多因素分析显示，肿瘤位置、种族、肿瘤大小、手术和TNM分期是年轻患者的独立预后因素。年轻患者预后较差在SYSUCC数据库中依然成立。我们的结果表明，<35岁的胃癌患者预后极差。在年轻人中早期发现胃癌至关重要。
