LaPelusa Michael, Shen Chan, Gillaspie Erin A, Cann Christopher, Lambright Eric, Chakravarthy A Bapsi, Gibson Michael K, Eng Cathy
Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Department of Surgery, Penn State College of Medicine, Hershey, PA 17033, USA.
Cancers (Basel). 2022 Jul 26;14(15):3633. doi: 10.3390/cancers14153633.
Background: Early-onset gastric cancer (EOGC), or gastric cancer in patients younger than 45 years old, is poorly understood and relatively uncommon. Similar to other gastrointestinal malignancies, the incidence of EOGC is rising in Western countries. It is unclear which populations experience a disproportionate burden of EOGC and what factors influence how patients with EOGC are treated. Methods: We conducted a retrospective, population-based study of patients diagnosed with gastric cancer from 2004 to 2018 using the National Cancer Database (NCDB). In addition to identifying unique demographic characteristics of patients with EOGC, we evaluated (using multivariable logistic regression controlling for year of diagnoses, primary site, and stage) how gender/sex, race/ethnicity, treatment facility type, payor status, and location of residence influenced the receipt of surgery, chemotherapy, and radiation. Results: Compared to patients 45−70 and >70 years of age with gastric cancer, patients with EOGC were more likely to be female, Asian/Pacific Islander (PI), African American (AA), Hispanic, uninsured, and present with stage IV disease. On multivariable analysis, several differences among subsets of patients with EOGC were identified. Female patients with EOGC were less likely to receive surgery and chemotherapy than male patients with EOGC. Asian/Pacific Islander patients with EOGC were more likely to receive chemotherapy and less likely to receive radiation than Caucasian patients with EOGC. African American patients were more likely to receive chemotherapy than Caucasian patients with EOGC. Hispanic patients were more likely to receive surgery and chemotherapy and less likely to receive radiation than Caucasian patients with EOGC. Patients with EOGC treated at community cancer centers were more likely to receive surgery and less likely to receive chemotherapy than patients with EOGC treated at academic centers. Uninsured patients with EOGC were more likely to receive surgery and less likely to receive chemotherapy than privately insured patients with EOGC. Patients with EOGC living in locations not adjacent to metropolitan areas were less likely to receive surgery compared to patients with EOGC who resided in metropolitan areas, Conclusions: Patients with EOGC are a demographically distinct population. Treatment of these patients varies significantly based on several demographic factors. Additional analysis is needed to elucidate why particular groups are more affected by EOGC and how treatment decisions are made for, and by, these patients.
早发性胃癌（EOGC），即45岁以下患者所患的胃癌，目前人们对其了解甚少且相对不常见。与其他胃肠道恶性肿瘤类似，西方国家早发性胃癌的发病率正在上升。尚不清楚哪些人群承受着不成比例的早发性胃癌负担，以及哪些因素影响早发性胃癌患者的治疗方式。方法：我们使用国家癌症数据库（NCDB）对2004年至2018年期间被诊断为胃癌的患者进行了一项基于人群的回顾性研究。除了确定早发性胃癌患者的独特人口统计学特征外，我们还评估了（使用多变量逻辑回归，控制诊断年份、原发部位和分期）性别/性别、种族/族裔、治疗机构类型、支付者状态和居住地点如何影响手术、化疗和放疗的接受情况。结果：与45 - 70岁及70岁以上的胃癌患者相比，早发性胃癌患者更可能为女性、亚裔/太平洋岛民（PI）、非裔美国人（AA）、西班牙裔、未参保者，且就诊时为IV期疾病。在多变量分析中，发现早发性胃癌患者亚组之间存在一些差异。早发性胃癌女性患者接受手术和化疗的可能性低于早发性胃癌男性患者。早发性胃癌亚裔/太平洋岛民患者比早发性胃癌白种人患者更可能接受化疗，而接受放疗的可能性更小。非裔美国患者比早发性胃癌白种人患者更可能接受化疗。早发性胃癌西班牙裔患者比早发性胃癌白种人患者更可能接受手术和化疗，而接受放疗的可能性更小。在社区癌症中心接受治疗的早发性胃癌患者比在学术中心接受治疗的早发性胃癌患者更可能接受手术，而接受化疗的可能性更小。未参保的早发性胃癌患者比有私人保险的早发性胃癌患者更可能接受手术，而接受化疗的可能性更小。与居住在大都市地区的早发性胃癌患者相比，居住在与大都市地区不相邻地区的早发性胃癌患者接受手术的可能性更小。结论：早发性胃癌患者在人口统计学上是一个独特的群体。这些患者的治疗因多种人口统计学因素而有显著差异。需要进一步分析以阐明为什么特定群体受早发性胃癌影响更大，以及如何为这些患者做出治疗决策以及这些患者如何做出治疗决策。
