Liu J D, Yang C L, Jin P L, Li B S, Zhao J J, Li H J, Wang X F, Sun Y H
Department of Gastrointestinal Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2024 May 25;27(5):452-456. doi: 10.3760/cma.j.cn441530-20240326-00111.
To clarify the clinicopathological features, prognosis, and recurrence pattern of early-onset gastric cancer (EOGC). Using data from the gastric cancer database of Zhongshan Hospital, Fudan University, we performed a retrospective, large-scale, real-world study of 5046 patients with gastric cancer who had undergone redical or palliative gastrectomy from January 2013 to December 2018, including 425 patients with EOGC (age ≤45 years) and 4621 controls. All those patients were pathologically confirmed adenocarcinoma with complete follow-up of five years. Residue gastric cancer and patients without complete clinical or follow-up data were excluded. We used a combination of outpatient and telephone follow-up, ending in October 2022 (median duration of follow-up 60 months), and compared the clinicopathological features and prognosis of the two groups. The clinicopathological features of EOGC included female predominance (61.1% [262/425 vs. 26.3% [1217/4621], χ=234.215, <0.001), fewer comorbidities (31.3% [133/425] vs. 58.5% [2703/4621], χ=34.378, <0.001), poorer differentiation (90.6% [385/425] vs. 78.2% [3614/4621], χ=30.642, <0.001), higher proportion of diffuse type (53.9% [229/425] vs. 18.3% [846/4621], χ=274.474, <0.001), higher proportion of T4 stage (44.7% [190/425] vs. 37.5% [1733/4621], χ=17.535, =0.001), more lymph node metastases (60.5% [257/425] vs. 53.9% [2491/4621], χ=6.764, =0.009), and higher proportion of pathological stage III/IV (47.5% [202/425] vs. 42.4% [1959/4621], χ=4.093, =0.043). The 5-year overall survival rates of the EOGC and control groups were 55.1% and 49.1%, respectively. Overall survival was significantly better in the EOGC than in the control group (<0.001). According to subgroup analysis, the prognosis of pathological stage I/II/III EOGC was better than that of the control group. Recurrence rates were similar in the two groups, whereas patients with EOGC had a higher proportion of peritoneal recurrence (7.8% [33/425] vs. 3.2% [146/4621], χ=23.741, <0.001) and a lower proportion of distant metastasis (4.9% [21/425] vs. 8.3% [385/4621], χ=6.247, =0.012). EOGC has unique clinicopathological features and recurrence patterns and resectable EOGC has a better prognosis, suggesting that patients with EOGC should be actively treated with the focus on preventing peritoneal recurrence.
为明确早发性胃癌（EOGC）的临床病理特征、预后及复发模式。利用复旦大学附属中山医院胃癌数据库的数据，我们对2013年1月至2018年12月期间接受根治性或姑息性胃切除术的5046例胃癌患者进行了一项回顾性、大规模、真实世界研究，其中包括425例EOGC患者（年龄≤45岁）和4621例对照。所有这些患者均经病理确诊为腺癌，并进行了为期五年的完整随访。排除残胃癌患者及临床或随访数据不完整的患者。我们采用门诊随访和电话随访相结合的方式，随访截止于2022年10月（中位随访时间60个月），并比较了两组的临床病理特征及预后。EOGC的临床病理特征包括女性占优势（61.1%[262/425]对26.3%[1217/4621]，χ=234.215，<0.001）、合并症较少（31.3%[133/425]对58.5%[2703/4621]，χ=34.378，<0.001）、分化较差（90.6%[385/425]对78.2%[3614/4621]，χ=30.642，<0.001）、弥漫型比例较高（53.9%[229/425]对18.3%[846/4621]，χ=274.474，<0.001）、T4期比例较高（44.7%[190/425]对37.5%[1733/4621]，χ=17.535，=0.001）、淋巴结转移较多（60.5%[257/425]对53.9%[2491/4621]，χ=6.764，=0.009）以及病理Ⅲ/Ⅳ期比例较高（47.5%[202/425]对42.4%[1959/4621]，χ=4.093，=0.043）。EOGC组和对照组的5年总生存率分别为55.1%和49.1%。EOGC组的总生存明显优于对照组（<0.001）。根据亚组分析，病理Ⅰ/Ⅱ/Ⅲ期EOGC的预后优于对照组。两组的复发率相似，而EOGC患者的腹膜复发比例较高（7.8%[33/425]对3.2%[146/4621]，χ=23.741，<0.001），远处转移比例较低（4.9%[21/425]对8.3%[385/4621]，χ=6.247，=0.012）。EOGC具有独特的临床病理特征和复发模式，可切除的EOGC预后较好，提示EOGC患者应积极治疗，重点预防腹膜复发。
