GASTRIC ADENOCARCINOMA IN PATIENTS 40 YEARS OF AGE OR YOUNGER

BACKGROUND: Gastric adenocarcinoma is considered a disease of the midd le aged and elderly and has been infrequently reported in patients und er 40 years of age. The purpose of this study was to determine the pro portion of young patients diagnosed with gastric adenocarcinoma and to compare the demographic, clinical and pathologic features of younger and older patients with gastric adenocarcinoma. METHODS: A retrospecti ve cohort study using tumor registry records of all patients' with gas tric adenocarcinoma diagnosed from 1982 through 1996 at a public teach ing hospital, Demographic, clinical, and pathologic comparisons were m ade between patients younger than 41 years of age and race- and sex-ma tched older patients with gastric adenocarcinoma. RESULTS: Thirty of 2 03 (15%) cases of gastric adenocarcinoma were diagnosed in patients le ss than 41 years (range 23 to 40). Male to female ratio was 1:1. Young patients were more likely to be black (33% versus 17%, P = 0.04). Bot h younger and older patients presented with advanced disease, with nea rly half of each group having metastases. Twelve of 29 (41%) younger p atients were operated on without a histologic diagnosis of gastric ade nocarcinoma in contrast to only 1 older patient (P < 0.001), One of 30 (3%) young patients is alive 39 months following gastrectomy. Twenty patients died and the remaining 9 were lost to follow-up, all with kno wn residual or recurrent disease, Six-month survival of young patients (23%) was less than older patients (42%) (P = 0.14). Young patients w ere more likely to have diffuse histology (80% versus 55%, P = 0.12). Overt infection with Helicobacter pylori was uncommon in both groups, CONCLUSIONS: Young patients accounted for an unusually high proportion of patients with gastric adenocarcinoma diagnosed at our public teach ing hospital. Young patients were significantly more likely to be blac k and less likely to have an accurate preoperative histologic diagnosi s. Both young and older patients presented with advanced disease and h ad poor survival, Young patients were more likely to have diffuse hist ology and had poorer 6-month survival, suggesting a snore aggressive v ariety of the disease in this group. (C) 1996 by Excerpta Medica, Inc.