Researchers from the University of California at Irvine have reported that patients with gastric cancer who are 35 years of age or younger have more aggressive disease than older patients with gastric cancer. The details of this study appeared in the June 2009 issue of the Archives of Surgery.[1]

Gastric cancer is usually thought of as occurring in older individuals and those at high risk due to ethnic group and diet. Other studies have suggested that more than half the cases of gastric cardia adenocarcinoma can be attributed to smoking or obesity. It has also been suggested that over 50% of the cases of noncardia gastric adenocarcinoma can be attributed to smoking, gastric ulcers, elevated dietary nitrite intake, or H. pylori infection.

However, a significant number of young individuals develop gastric cancer; the causes for this are not at all clear. In some patients gastric cancer is hereditary and related to germline mutations in the gene for cell adhesion protein E-cadherin. This type of cancer is generally diffuse and has a poor prognosis. Younger patients with gastric cancer tend to more often have disease in the upper stomach and to more often have a diffuse histology compared with older individuals with gastric cancers. There is currently a controversy over whether or not younger individuals with gastric cancer have a worse outcome than older individuals with gastric cancer. This may be related to the definition of younger versus older, as 45 years is usually the cutoff for analysis in most studies that find no differences in outcome between older and younger individuals.

In the current study researchers used age 35 and younger to define a “young” population. They found that patients in this age group made up 9% of 350 patients with gastric cancer. They reported the following differences between younger and older patients with gastric cancer:

• 93% of younger patients had a diffuse-type histology compared with 69% of older patients.
• Younger patients had adjacent organ invasion in 74% of cases compared with 29% of older patients.
• Nodal metastases occurred in 94% of younger and 70% of older patients.
• Distant metastases occurred in 81% of younger and 50% of older patients.
• 90% of younger patients had Stage IV disease compared with 64% of older patients.
• Potentially curative gastrectomy was performed in 17% of younger and 58% of older patients.
• Postoperative mortality was 22% for younger patients and 2% for older patients.
• Mean survival was 11.6 months for younger and 33.4 months for older patients.

Comments: The adverse outcomes of this group of young patients are due primarily to more aggressive disease and diagnosis at an advanced stage. These data suggest that we need to know more about the risk factors for development of gastric cancer in younger individuals, which may be totally different from older patients. Currently, effective screening can only be carried out for persons at risk for the hereditary form of gastric cancer. Until effective screening is available, young patients who develop gastric cancer are likely to continue to present with advanced disease.

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