Stryelkina Maryana, Nguyen My, Reddy Priyanka, Doan Anh Trinh, Min Michelle, Go Lisa, Wong Lucas
Division of Internal Medicine, Department of Medicine, Baylor Scott & White Medical Center, Temple, Texas, USA.
Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Temple, Texas, USA.
Proc (Bayl Univ Med Cent). 2025 Apr 22;38(4):388-396. doi: 10.1080/08998280.2025.2488592. eCollection 2025.
Early onset gastric cancer (EOGC), defined as gastric cancer occurring in individuals aged 49 years or younger, presents distinct clinical and molecular characteristics compared to late-onset gastric cancer (LOGC). Despite the increasing incidence of EOGC, limited data exist regarding its demographic, risk factor, and molecular profiles. This study aimed to compare the clinicopathologic and molecular features of EOGC and LOGC and characterize the demographic, clinical, and molecular characteristics of EOGC in a diverse cohort to elucidate potential risk factors and disease behavior.
A retrospective cohort study was conducted on 437 gastric carcinoma patients screened at Baylor Scott & White Health (2002-2022). Demographic, clinical, and molecular data, including infection, lifestyle factors, histopathology, and biomarkers (HER2, MSI), were analyzed.
Of the 437 gastric carcinoma cases screened, 32 patients had EOGC, while 51 had LOGC with available clinical and molecular data. EOGC was associated with a higher proportion of females ( = 0.001) and greater racial/ethnic diversity, including a higher prevalence of Hispanic (41% vs 13.7%) and African American patients (34.3% vs 13.7%). Modifiable risk factor analysis revealed a significant association between EOGC and infection ( = 0.001), whereas alcohol use was more common in LOGC ( = 0.041). EOGC was more frequently diagnosed at advanced stages ( = 0.02) and exhibited a higher prevalence of signet ring cell carcinoma ( = 0.003) and poorly differentiated tumors ( < 0.001). Molecular analysis showed low HER2 positivity (4.2%) and mismatch repair deficiency (8.3%) in EOGC, suggesting distinct molecular features. The overall 5-year survival rate for EOGC was 22.6%, significantly lower in patients diagnosed at advanced stages (III/IV 5.9% vs I/II 63.6%, = 0.028).
This study underscores the aggressive nature of EOGC, highlighting its advanced-stage presentation, poor survival, and distinct molecular pathways. The high prevalence of infection, obesity, and smoking reinforces the need for targeted prevention strategies. Given its rising incidence and late-stage diagnosis, risk-based screening, optimized treatment protocols, and novel therapeutic strategies are crucial for improving patient outcomes.
早发性胃癌（EOGC）定义为发生在49岁及以下个体的胃癌，与晚发性胃癌（LOGC）相比，具有独特的临床和分子特征。尽管EOGC的发病率不断上升，但关于其人口统计学、危险因素和分子特征的数据有限。本研究旨在比较EOGC和LOGC的临床病理和分子特征，并在一个多样化的队列中描述EOGC的人口统计学、临床和分子特征，以阐明潜在的危险因素和疾病行为。
对在贝勒斯科特与怀特健康中心筛查的437例胃癌患者（2002 - 2022年）进行回顾性队列研究。分析了人口统计学、临床和分子数据，包括感染、生活方式因素、组织病理学和生物标志物（HER2、微卫星不稳定性）。
在筛查的437例胃癌病例中，32例为EOGC，51例为LOGC且有可用的临床和分子数据。EOGC与女性比例较高（P = 0.001）以及更大的种族/民族多样性相关，包括西班牙裔（41%对13.7%）和非裔美国患者（34.3%对13.7%）的患病率较高。可改变危险因素分析显示EOGC与感染之间存在显著关联（P = 0.001），而饮酒在LOGC中更为常见（P = 0.041）。EOGC在晚期更频繁被诊断出（P = 0.02），且印戒细胞癌（P = 0.003）和低分化肿瘤的患病率较高（P < 0.001）。分子分析显示EOGC中HER2阳性率低（4.2%）和错配修复缺陷率低（8.3%），提示其具有独特的分子特征。EOGC的总体5年生存率为22.6%，在晚期诊断的患者中显著较低（III/IV期为5.9%对I/II期为63.6%，P = 0.028）。
本研究强调了EOGC的侵袭性，突出了其晚期表现、较差的生存率和独特的分子途径。感染、肥胖和吸烟的高患病率强化了针对性预防策略的必要性。鉴于其发病率上升和晚期诊断情况，基于风险的筛查、优化的治疗方案和新型治疗策略对于改善患者预后至关重要。
