Clinicopathologic Features, Survival Outcome, and Prognostic Factors in Gastric Cancer Patients 18-40 Years of Age

Purpose: Whether young patients with gastric cancer (GC) had a distinct prognostic outcome from older patients remains controversial. The objective of this study was to investigate the clinicopathologic characteristics and prognostic factors of young GC patients and evaluate the survival outcome in comparison to their older counterparts. Methods: We retrospectively reviewed clinicopathologic and survival data of 2022 patients who underwent curative resection for GC. All patients were divided into the young patient group (18-40 years) and older patient group (>40 years) according to the patient age. Clinicopathologic characteristics and prognostic factors of young GC patients were analyzed, and the survival difference between the two groups was compared. Results: The incidence of GC in the patients 18-40 years of age was 8.1% (164/2022). The young patient group had different clinicopathologic features from the older group, including a significant female predominance, a larger number of retrieved lymph nodes, a higher proportion of undifferentiated histology type, and middle or lower 1/3 GC. However, the survival outcome of young patients was similar to that of their older counterparts (5-year disease free survival [DFS]: 47.0% vs. 44.0%, p = 0.247), even when comparison based on the TNM stage was made. Deeper tumor invasion (T3-T4 stage, hazard ratios [HR]: 5.791, 95% confidence intervals [CIs]: 2.908-11.533, p < 0.001), lymph node metastasis (HR: 2.500, 95% CIs: 1.308-4.781, p = 0.006), and lymphovascular invasion (HR: 2.191, 95% CIs: 1.306-3.677, p = 0.003) were independent prognostic factors for young GC patients. Conclusions: Young age (18-40 years) was not associated with poorer survival outcome in GC patients. However, early diagnosis and curative resection with adequate lymphadenectomy will still be necessary for improving the survival outcome of young GC patients.