Yasinzai Abdul Qahar Khan, Saeed Anwaar
Department of Medicine, Division of Medical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA.
UPMC Hillman Cancer Center, Pittsburgh, PA, 15232, USA.
J Gastrointest Cancer. 2025 Mar 13;56(1):78. doi: 10.1007/s12029-025-01168-1.
Gastric cancer (GC) is the 5th most common malignancy worldwide. Adenocarcinoma accounts for 95% of all GC. While most cases of gastric adenocarcinoma (GAC) arise in older age males, a significant proportion of biological disparity exists between different ages. In this study, we aim to compare the demographics and prognostic outcomes of different ages of patients with GAC.
This retrospective study utilized the GAC cases abstracted from the Surveillance, Epidemiology, and End Results Program's 17 registries dataset from 2000 to 2020. Cases were divided into different age group brackets to comparatively explore characteristics of GAC.
A total of 103,674 cases were identified. The median age was 69 years, with a significant proportion 39.7% (n = 41,154) falling within the 66-80 age bracket cases. Female proportions were higher in the ≤ 35 years age group 47.2% (n = 960) and ≥ 81 years age group 45.7% (n = 9,695). About 45.1% (n = 916) of ≤ 35 years age group cases were Hispanic, while 60% (n = 12,715) of ≥ 81 years age group cases were non-Hispanic White. Ages between 51-65 and 66-80 years had higher proportions of liver metastasis 17% and 16% than their younger and older peers. Age ≤ 35 years cases are more likely to present at cardia 20.5%. Male gender had the worst survival across all age groups, with the worst in the ≤ 35 age group hazard ratio (H.R) 1.22(1.007 - 1.250 p < 0.001). Black had the worst survival across all ages, with the worst in the ≤ 35 years age group H.R 1.405 (1.164 - 1.696 p < 0.001). When plotted against other races in each age group, Hispanics had poor survival at young ages H.R 1.224 (1.069 - 1.401) and superior survival at older ages, with H.R 0.944 (0.902 - 0.987) in the ≥ 81 age group. Tumors located in the greater curvature and overlapping lesions demonstrated worse prognosis compared to cardia. Conversely, tumors in the pylorus and lesser curvature generally exhibited better prognosis.
In the United States GAC predominantly affects older adults, but early-onset cases exhibit aggressive histologies and poor survival, particularly more common in Hispanics. Black individuals face the worst survival outcomes across all age groups. Gender inclination towards males shrinks at the extremes of ages. At different age brackets, the demographics and prognosis changes, necessitating customized interventions.
胃癌（GC）是全球第五大常见恶性肿瘤。腺癌占所有胃癌的95%。虽然大多数胃腺癌（GAC）病例发生在老年男性中，但不同年龄之间存在显著的生物学差异。在本研究中，我们旨在比较不同年龄的GAC患者的人口统计学和预后结果。
这项回顾性研究利用了从2000年到2020年监测、流行病学和最终结果计划的17个登记处数据集中提取的GAC病例。病例被分为不同的年龄组，以比较探索GAC的特征。
共识别出103,674例病例。中位年龄为69岁，其中39.7%（n = 41,154）的病例年龄在66 - 80岁之间。女性比例在≤35岁年龄组中较高，为47.2%（n = 960），在≥81岁年龄组中为45.7%（n = 9,695）。≤35岁年龄组病例中约45.1%（n = 916）为西班牙裔，而≥81岁年龄组病例中60%（n = 12,715）为非西班牙裔白人。51 - 65岁和66 - 80岁年龄组的肝转移比例分别为17%和16%，高于其年轻和年长的同龄人。≤35岁年龄组的病例更有可能出现在贲门部，占20.5%。男性在所有年龄组中的生存率最差，在≤35岁年龄组中危险比（H.R）为1.22（1.007 - 1.250，p < 0.001）。黑人在所有年龄段中的生存率最差，在≤35岁年龄组中H.R为1.405（1.164 - 1.696，p < 0.001）。在每个年龄组中与其他种族相比，西班牙裔在年轻时生存率较差，H.R为1.224（1.069 - 1.401），而在老年时生存率较好，在≥81岁年龄组中H.R为0.944（0.902 - 0.987）。与贲门部相比，位于大弯侧和重叠病变的肿瘤预后较差。相反，幽门部和小弯侧的肿瘤通常表现出较好的预后。
在美国，GAC主要影响老年人，但早发病例表现出侵袭性组织学特征和较差的生存率，特别是在西班牙裔中更为常见。黑人在所有年龄组中面临最差的生存结果。性别对男性的倾向在年龄极端情况下缩小。在不同年龄组中，人口统计学和预后发生变化，需要定制干预措施。
