Yin Shi, Zhai Xiaohui, Li Yaoying, Zeng Ruixin, Zhang Di, Sun Xiaoqing, Zhang Ziying, Wang Huashe, Wang Caiqin
The Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Zhejiang, China.
Department of Medical Oncology, The Sixth Affiliated Hospital of Sun-Yat sen University, Guangzhou, People's Republic of China.
Cancer Med. 2025 Mar;14(5):e70737. doi: 10.1002/cam4.70737.
The increasing incidence of gastric cancer (GC) in younger populations, coupled with population aging, has highlighted distinct age-related subtypes with unique clinical characteristics and outcomes. Although younger patients tend to have more aggressive tumors, the prognostic factors for early-onset gastric cancer (EOGC) remain underexplored. This study is dedicated to providing a comprehensive and in-depth analysis of prognostic factors in EOGC, aiming to refine personalized treatment strategies under the precision medicine paradigm.
This retrospective study encompassed 413 local cohort EOGC patients and 8447 Surveillance, Epidemiology, and End Results database patients diagnosed with GC. Survival outcomes were assessed using Kaplan-Meier survival curves, and differences between groups were evaluated with the log-rank test. Prognostic factors were identified through logistic regression and Cox proportional hazards models. Mediation analysis was conducted to assess the indirect effects of clinical factors on EOGC and prognosis. Biomarker comparisons between bone metastasis early-onset gastric cancer and non-bone metastasis early-onset gastric cancer groups were evaluated using the Wilcoxon test for significant differences.
The overall survival and cancer-specific survival rates in the EOGC group were significantly lower than those in the non-early-onset gastric cancer group (p < 0.05). However, EOGC itself was not an independent risk factor for poor prognosis. Mediation analysis revealed that the adverse impact of EOGC on prognosis was predominantly mediated by metastasis, with bone metastasis identified as the most significant factor. Furthermore, bone metastasis emerged as an independent predictor of poor prognosis in EOGC patients, potentially linked to elevated coagulation markers, increased inflammation-related cytokines, and an imbalance in peripheral blood immune cell ratios.
Bone metastasis significantly contributes to the poor prognosis of EOGC. EOGC patients with bone metastasis demonstrate immune suppression, inflammation activation, and coagulopathy, highlighting the need for tailored management and prognostic strategies.
胃癌（GC）在年轻人群中的发病率不断上升，再加上人口老龄化，凸显了具有独特临床特征和预后的不同年龄相关亚型。尽管年轻患者的肿瘤往往更具侵袭性，但早发性胃癌（EOGC）的预后因素仍未得到充分研究。本研究致力于对EOGC的预后因素进行全面深入分析，旨在完善精准医学模式下的个性化治疗策略。
这项回顾性研究纳入了413例本地队列EOGC患者和8447例诊断为GC的监测、流行病学和最终结果数据库患者。使用Kaplan-Meier生存曲线评估生存结果，并用对数秩检验评估组间差异。通过逻辑回归和Cox比例风险模型确定预后因素。进行中介分析以评估临床因素对EOGC和预后的间接影响。使用Wilcoxon检验评估骨转移早发性胃癌组和非骨转移早发性胃癌组之间的生物标志物差异是否具有统计学意义。
EOGC组的总生存率和癌症特异性生存率显著低于非早发性胃癌组（p < 0.05）。然而，EOGC本身并不是预后不良的独立危险因素。中介分析显示，EOGC对预后的不利影响主要由转移介导，其中骨转移被确定为最显著的因素。此外，骨转移是EOGC患者预后不良的独立预测因素，可能与凝血标志物升高、炎症相关细胞因子增加以及外周血免疫细胞比例失衡有关。
骨转移显著导致EOGC预后不良。发生骨转移的EOGC患者表现出免疫抑制、炎症激活和凝血病，突出了制定针对性管理和预后策略的必要性。
