Clinicopathological features and prognostic factors of gastric cancer patients aged 40 years or younger

Background and Objectives Gastric adenocarcinoma (GC) occurs frequently in the sixth decade of life and is uncommon in patients aged 40 years or younger. The aims of this study were to define the clinicopathological features and elucidate the prognostic factors of GC in the young. Methods Between 1998 and 2006, 1,815 GC patients undergoing resection were enrolled in a prospective database. The findings for 115 (6.0%) patients aged 40 years or younger were compared with those of 1,009 patients between 56 and 75 years old. Results The group of young patients with GC included significantly more women than the group of old patients (60.0% vs. 37.0%, respectively); young patients also had more T4 lesions (73.9% vs. 61.6%), undifferentiated tumors (85.2% vs. 55.1%), severe desmoplasia (41.4% vs. 12.2%), Lauren's diffuse-type cancers (55.6% vs. 27.7%), and perineural invasion (69.1% vs. 46.1%). Survival rates in younger patients at 3, 5, and 10 years after resection were 56.8%, 52.0%, and 42.1%, respectively, similar to those in older patients (P=0.411). Unfavorable independent prognostic factors of GC in the young were degree of nodal involvement (N3 vs. N0; P=0.001), advanced T status (T3-4 vs. T1-2; P=0.015), tumor size (>4 vs. P0.019), and status of resection margins (positive vs. negative; P0.044). Conclusions GC tends to exhibit more aggressive tumor behavior in young patients than in old patients; however, the surgical survival of young and old patients was similar. Advanced nodal involvement (N3) is the most important independent prognostic factor in the young.