Torrejon Nataly V, Deshpande Saarang, Wei Wei, Tullio Katherine, Kamath Suneel D
Cleveland Clinic Foundation, Cleveland, OH.
University of Pennsylvania, Philadelphia, PA.
JCO Oncol Pract. 2022 May;18(5):e759-e769. doi: 10.1200/OP.21.00692.
The proportion of gastroesophageal junction adenocarcinoma is increasing. This study evaluated trends in early-onset gastric and esophageal cancers and compared socioeconomic and clinical characteristics between early-onset versus late-onset disease.
We included all patients with gastric and esophageal cancer from 2004 to 2015 from the National Cancer Database. Patients were categorized by age < 50, 50-69, and ≥ 70 years. Differences in pathologic and socioeconomic factors between early-onset and late-onset cancers were assessed by using chi-square test. The effects of demographic and socioeconomic factors on overall survival (OS) were assessed using Cox models.
The proportion of patients with early-onset gastric cancer increased from 23.9% in 2004-2006 to 26.2% in 2013-2015, whereas the proportion of early-onset esophageal cancer decreased from 27.3% in 2004-2006 to 23.1% in 2013-2015. For both malignancies, the early-onset group was more likely to be Black or Hispanic and more likely to be diagnosed with stage IV cancer. Black patients had the worst median OS in both malignancies. In gastric cancer, within the Black patient group, patients experienced worse OS if they had government insurance versus private insurance (hazard ratio 1.2; 95% CI, 1.1 to 1.3; value < .0001) or if they were in the lowest community median income category versus the highest category (hazard ratio 1.2; 95% CI, 1.1 to 1.3; value < .0001).
Early-onset gastric cancer is increasing, whereas early-onset esophageal cancer is declining. Early-onset gastric cancer disproportionately affects non-White patients, particularly Hispanic patients. Black patients have worse outcomes compared with other races for both gastric and esophageal cancer.
胃食管交界腺癌的比例正在上升。本研究评估了早发性胃癌和食管癌的发病趋势，并比较了早发性疾病与晚发性疾病之间的社会经济和临床特征。
我们纳入了2004年至2015年来自国家癌症数据库的所有胃癌和食管癌患者。患者按年龄分为<50岁、50 - 69岁和≥70岁三组。采用卡方检验评估早发性和晚发性癌症在病理和社会经济因素方面的差异。使用Cox模型评估人口统计学和社会经济因素对总生存期（OS）的影响。
早发性胃癌患者的比例从2004 - 2006年的23.9%上升至2013 - 2015年的26.2%，而早发性食管癌的比例从2004 - 2006年的27.3%降至2013 - 2015年的23.1%。对于这两种恶性肿瘤，早发性组更有可能是黑人或西班牙裔，且更有可能被诊断为IV期癌症。黑人患者在这两种恶性肿瘤中的中位总生存期最差。在胃癌中，在黑人患者群体中，如果患者拥有政府保险而非私人保险（风险比1.2；95%置信区间，1.1至1.3；P值<0.0001），或者处于社区收入中位数最低类别而非最高类别（风险比1.2；95%置信区间，1.1至1.3；P值<0.0001），则其总生存期更差。
早发性胃癌呈上升趋势，而早发性食管癌呈下降趋势。早发性胃癌对非白人患者，尤其是西班牙裔患者的影响尤为严重。与其他种族相比，黑人患者在胃癌和食管癌方面的预后更差。
