Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Paseo de La Castellana, 261, 28046, Madrid, Spain.
Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain.
Gastric Cancer. 2024 Jan;27(1):131-145. doi: 10.1007/s10120-023-01443-9. Epub 2023 Nov 15.
Gastroesophageal adenocarcinoma in young adults (GCYA) counts for 10-15% of diagnoses. Previous studies have mainly focused on surgical outcomes in patients with resectable tumors; however, systemic therapy for advanced GCYA remains under-evaluated. This study aims to assess the efficacy-related outcomes and safety of first-line chemotherapy (CT) in younger versus older patients with advanced gastroesophageal adenocarcinoma.
Patients with advanced gastroesophageal adenocarcinoma from the AGAMENON-SEOM registry treated with first-line polychemotherapy between January 2008 and October 2022 were included. We compared clinicopathological features, therapies received, efficacy-related outcomes, and toxicity between individuals aged < and ≥ 45 years.
Out of 3386 patients, 263 (7.8%) were < 45 years. Young patients exhibited a higher proportion of females affected, lower ECOG-PS ≥ 2, fewer comorbidities, and more aggressive disease-related features, such as higher proportion of diffuse subtype, signet-ring cells, plastic linitis, grade 3, peritoneal metastases and metastatic disease at diagnosis. They received more triple-agent combinations and underwent more surgeries in metastatic setting. No significant differences were observed between groups in overall response rate (53.1% vs. 52.3% in < and ≥ 45 years, respectively, p = 0.579), progression-free survival (6.1 vs. 6.83 months, p = 0.158) and overall survival (11.07 vs. 10.81 months, p = 0.82), even after adjusting for potential confounding factors. Grade 3-4 adverse events were comparable in both groups, although toxicity leading to treatment discontinuation was more frequent in older patients.
In the AGAMENON-SEOM registry, younger patients with GCYA exhibited more aggressive clinicopathological features, and despite receiving more aggressive treatments, similar efficacy outcomes and toxicity profiles were achieved compared to their older counterparts. In the AGAMENON-SEOM registry, GEAC in < 45 years showed more aggressive clinicopathological features and, although treated with more intense first-line CT regimens, similar efficacy outcomes and toxicity were achieved compared to older patients.
青年人胃食管腺癌（GCYA）占诊断病例的 10-15%。先前的研究主要集中在可切除肿瘤患者的手术结果上；然而，晚期 GCYA 的系统治疗仍未得到充分评估。本研究旨在评估一线化疗（CT）在年轻和老年晚期胃食管腺癌患者中的疗效相关结局和安全性。
纳入 2008 年 1 月至 2022 年 10 月 AGAMENON-SEOM 登记处接受一线多化疗的晚期胃食管腺癌患者。我们比较了年龄<45 岁和年龄≥45 岁患者的临床病理特征、接受的治疗、疗效相关结局和毒性。
在 3386 名患者中，有 263 名（7.8%）年龄<45 岁。年轻患者中，女性患者比例较高，ECOG-PS≥2 的比例较低，合并症较少，疾病相关特征更为侵袭性，如弥漫型、印戒细胞型、塑性黏膜浸润型、G3 级、腹膜转移和诊断时转移性疾病的比例较高。他们接受了更多的三联药物组合，并在转移性疾病中进行了更多的手术。两组之间的总缓解率（分别为<45 岁和≥45 岁的 53.1%和 52.3%，p=0.579）、无进展生存期（6.1 与 6.83 个月，p=0.158）和总生存期（11.07 与 10.81 个月，p=0.82）均无显著差异，即使在调整了潜在混杂因素后也是如此。两组的 3-4 级不良事件相当，但老年患者因毒性而停止治疗的情况更为频繁。
在 AGAMENON-SEOM 登记处，GCYA 的年轻患者表现出更具侵袭性的临床病理特征，尽管接受了更具侵袭性的治疗，但与年龄较大的患者相比，他们的疗效结果和毒性谱相似。在 AGAMENON-SEOM 登记处，<45 岁的 GEAC 表现出更具侵袭性的临床病理特征，尽管接受了更强化的一线 CT 方案治疗，但与老年患者相比，疗效结果和毒性相似。
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