Specifics of Young Gastric Cancer Patients: A Population-Based Analysis of 46,110 Patients with Gastric Cancer from the German Clinical Cancer Registry Group

SIMPLE SUMMARY: The incidence of gastric cancer shows marked age variations, and it is most frequently diagnosed in middle-aged and elderly patients between the ages 50 and 70. However, 2–8% of all gastric cancer occurs at a younger age, also known as early-onset gastric cancer. Studies characterizing this cohort of young patients with gastric cancer are scarce. The prognosis for this group of young patients with gastric cancer remains controversial, and it is unclear how to define the “young patient”. The objective of this study was to characterize age variations of gastric cancer in the German population using population-based registry data from the German Cancer Registry Group of the Society of German Tumor Centers—Network for Care, Quality and Research in Oncology (ADT)and to investigate whether a cohort of young patients can be identified who differ from elderly patients in terms of tumor stage at diagnosis, histology, and prognosis. In this study, we were able to objectively identify a cohort of patients referred to as early-onset gastric cancer by applying an approach that stratified relative distributions of histological subtypes of gastric adenocarcinoma according to age percentiles. With a median age of 53 years, this group of young patients showed more aggressive and advanced tumors and received significantly less curative treatment. However, survival of this early-onset gastric cancer patients was significantly better compared to elderly patients, both in general as well as stratified according to treatment. Young age was identified as an independent predictor for better survival in this study. ABSTRACT: Introduction: 2–8% of all gastric cancer occurs at a younger age, also known as early-onset gastric cancer (EOGC). The aim of the present work was to use clinical registry data to classify and characterize the young cohort of patients with gastric cancer more precisely. Methods: German Cancer Registry Group of the Society of German Tumor Centers—Network for Care, Quality and Research in Oncology (ADT)was queried for patients with gastric cancer from 2000–2016. An approach that stratified relative distributions of histological subtypes of gastric adenocarcinoma according to age percentiles was used to define and characterize EOGC. Demographics, tumor characteristics, treatment and survival were analyzed. Results: A total of 46,110 patients were included. Comparison of different groups of age with incidences of histological subtypes showed that incidence of signet ring cell carcinoma (SRCC) increased with decreasing age and exceeded pooled incidences of diffuse and intestinal type tumors in the youngest 20% of patients. We selected this group with median age of 53 as EOGC. The proportion of female patients was lower in EOGC than that of elderly patients (43% versus 45%; p < 0.001). EOGC presented more advanced and undifferentiated tumors with G3/4 stages in 77% versus 62%, T3/4 stages in 51% versus 48%, nodal positive tumors in 57% versus 53% and metastasis in 35% versus 30% (p < 0.001) and received less curative treatment (42% versus 52%; p < 0.001). Survival of EOGC was significantly better (five-years survival: 44% versus 31% (p < 0.0001), with age as independent predictor of better survival (HR 0.61; p < 0.0001). Conclusion: With this population-based registry study we were able to objectively define a cohort of patients referred to as EOGC. Despite more aggressive/advanced tumors and less curative treatment, survival was significantly better compared to elderly patients, and age was identified as an independent predictor for better survival.