Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
J Natl Cancer Inst. 2024 Feb 8;116(2):299-308. doi: 10.1093/jnci/djad186.
The rate of esophagogastric cancer is rising among individuals under 50 years of age. It remains unknown whether early-onset esophagogastric cancer represents a unique entity. This study investigated the clinical and molecular characteristics of early-onset and average-onset esophagogastric cancer .
We reviewed the Memorial Sloan Kettering Cancer Center gastric, esophageal, and gastroesophageal junction cancer database. Associations between baseline characteristics and tumor and germline molecular alterations were compared between those with early-onset and average-onset esophagogastric cancer using Fisher exact tests and the Benjamini-Hochberg method for multiple-hypothesis correction.
We included 1123 patients with early-onset esophagogastric cancer (n = 219; median age = 43 years [range = 18-49 years]) and average-onset esophagogastric cancer (n = 904; median age = 67 years [range = 50-94 years]) treated between 2005 and 2018. The early-onset group had more women (39% vs 28%, P = .002). Patients with early-onset esophagogastric cancer were more likely to have a gastric primary site (64% vs 44%, P < .0001). The signet ring cell and/or diffuse type was 3 times more common in the early-onset esophagogastric cancer group (31% vs 9%, P < .0001). Early-onsite tumors were more frequently genomically stable (31% vs 18%, P = .0002) and unlikely to be microsatellite instability high (2% vs 7%, P = .003). After restricting to adenocarcinoma and signet ring cell and/or diffuse type carcinomas, we observed no difference in stage (P = .40) or overall survival from stage IV diagnosis (median = 22.7 vs 22.1 months, P = .78).
Our study supported a preponderance of gastric primary disease sites, signet ring histology, and genomically stable molecular subtypes in early-onset esophagogastric cancer. Our findings highlight the need for further research to define the underlying pathogenesis and strategies for early detection and prevention.
50 岁以下人群的食管胃交界癌和胃癌发病率正在上升。目前尚不清楚早发性食管胃交界癌和胃癌是否代表一种独特的实体。本研究旨在研究早发性和平均发病年龄的食管胃交界癌和胃癌的临床和分子特征。
我们回顾了纪念斯隆凯特琳癌症中心的胃、食管和胃食管交界癌数据库。使用 Fisher 精确检验和 Benjamini-Hochberg 方法进行多重假设校正，比较早发性和平均发病年龄的食管胃交界癌和胃癌患者的基线特征与肿瘤和种系分子改变之间的关联。
我们纳入了 2005 年至 2018 年间接受治疗的 1123 例早发性食管胃交界癌（n=219；中位年龄 43 岁[范围 18-49 岁]）和平均发病年龄的食管胃交界癌（n=904；中位年龄 67 岁[范围 50-94 岁]）。早发性组女性患者更多（39%比 28%，P=0.002）。早发性食管胃交界癌患者胃原发灶更常见（64%比 44%，P<0.0001）。早发性食管胃交界癌组中，印戒细胞癌和/或弥漫型更常见（31%比 9%，P<0.0001）。早发性肿瘤更常为基因组稳定型（31%比 18%，P=0.0002），微卫星不稳定高型的可能性更小（2%比 7%，P=0.003）。在仅纳入腺癌和印戒细胞癌和/或弥漫型癌后，我们观察到两组的分期（P=0.40）或 IV 期诊断后的总生存时间无差异（中位值分别为 22.7 个月和 22.1 个月，P=0.78）。
本研究支持早发性食管胃交界癌和胃癌以胃原发疾病部位、印戒细胞组织学和基因组稳定的分子亚型为主。我们的研究结果强调需要进一步研究以明确潜在的发病机制和早期发现及预防策略。
