Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, Guangdong, People's Republic of China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China.
J Cancer Res Clin Oncol. 2023 Nov;149(16):14941-14952. doi: 10.1007/s00432-023-05210-2. Epub 2023 Aug 22.
Malignancies of the upper gastrointestinal tract are rare in early-onset patients outside the hereditary genetic disorders. There are few reports describing adenocarcinoma of the esophagogastric junction (AEG) in extremely early-onset patients aged under 50 years old. The aim of this study was to describe the clinicopathological features and prognosis of adenocarcinoma of esophagogastric junction (AEG) in early-onset patients among three successive periods: 1975-1989 (period 1), 1990-2004 (period 2), and 2005-2017 (period 3).
Between 1975 and 2017, data were extracted from the Surveillance, Epidemiology, and End Results database, and 18,278 patients with AEG were enrolled. Three age groups of patients were identified: < 50, 50-69, and ≥ 70 years of age. Clinicopathological characteristics and prognostic outcomes were reviewed and compared among three groups over three periods (1975-89, 1990-04, and 2005-2017). Multivariate Cox regression analysis was performed to adjust for covariate effects related to both overall survival (OS) and cancer-specific survival (CSS).
Among three age groups, early-onset patients were more likely to present with higher tumor grade, advanced nodal, and distant metastatic disease at diagnosis than other groups (p < 0.01 for both). In comparison to the older group, a higher proportion of patients in the early-onset group received chemotherapy and radiation treatment. After adjusting for covariates, early-onset patients had a better CSS and OS than elderly patients.
Early-onset AEG patients were more likely than other age groups to present with advanced disease upon diagnosis. However, the prognosis of early-onset patients was better than their older counterparts after adjustment for covariates. The dissimilarities in tolerance to treatment among early-onset, middle-aged, and elderly patients could be the reason for this difference.
在上消化道恶性肿瘤中，除遗传性遗传疾病外，早发患者很少见。很少有报道描述年龄在 50 岁以下的极早发患者的食管胃结合部腺癌（AEG）。本研究的目的是描述三个连续时期（1975-1989 年[第 1 期]、1990-2004 年[第 2 期]和 2005-2017 年[第 3 期]）中早发患者食管胃结合部腺癌（AEG）的临床病理特征和预后。
1975 年至 2017 年间，从监测、流行病学和结果数据库中提取数据，共纳入 18278 例 AEG 患者。将患者分为三组：<50 岁、50-69 岁和≥70 岁。回顾和比较了三个组在三个时期（1975-89、1990-04 和 2005-2017）的临床病理特征和预后结果。采用多变量 Cox 回归分析调整与总生存（OS）和癌症特异性生存（CSS）相关的协变量影响。
在三组中，早发患者的肿瘤分级更高，诊断时淋巴结和远处转移疾病更晚期，与其他组相比（两者均 p<0.01）。与老年组相比，早发组接受化疗和放疗的患者比例更高。在调整协变量后，早发组的 CSS 和 OS 均优于老年组。
早发 AEG 患者与其他年龄组相比，更有可能在诊断时出现晚期疾病。然而，在调整协变量后，早发患者的预后优于老年患者。早发、中年和老年患者对治疗的耐受性差异可能是导致这种差异的原因。
