UNIQUE FEATURES OF GASTRIC-CARCINOMA IN THE YOUNG - A POPULATION-BASED ANALYSIS

BACKGROUND. It is suspected that young patients with adenocarcinoma ha ve a more aggressive form of disease and therefore a poorer prognosis than older patients. METHODS. A retrospective cohort study used the po pulation-based tumor registries of Orange, San Diego, and Imperial Cou nties. Cases (patients age less than or equal to 40 years with gastric carcinoma) were compared with controls (patients age >40 years with g astric carcinoma). RESULTS. The overall, age-adjusted incidence rate o f gastric carcinoma was 10.2/100,000. Approximately 5.5% of 3,020 case s occurred in patients age <41 years. Young patients (especially white s and Latinos) were more likely to have distant metastases [45% versus 34%; odds ratio (OR) = 2.6; 95% confidence interval (CI), 1.4-4.8; P < 0.001]. The histology of young patients (especially Latinos and Asia ns) was more likely to be signet ring cell (28% versus 15%; OR = 2.3; 95% CI, 1.6-3.3; P < 0.001), and the grade of young patients (especial ly whites and Latinos) was more likely to be Grade 3 or 4 (according t o the World Health Organization International Classification of Diseas es for Oncology; 68% versus 56%; OR = 2.1; 95% CI, 1.4-3.3; P < 0.001) . The tumors of young patients (especially Asians) were less likely to be of the gastroesophageal junction (16% versus 27%; OR = 0.47; 95% C I, 0.31-0.72; P < 0.001) and of the antrum (17% versus 22%; OR = 0.62; 95% CI, 0.41-0.95; P = 0.03) than the gastric body. Younger patients were more likely to receive chemotherapy (50% versus 28%; OR = 2.7; 95 % CI, 1.9-3.7; P < 0.001). Only patients age >70 years had an independ ent increased risk of dying from all causes in comparison with young p atients (relative risk = 1.46; P = 0.01). CONCLUSIONS. Young gastric c arcinoma patients have adverse clinical and pathologic features in com parison with older patients. In this study, young age was not found to be an independent predictor of overall survival. (C) 1998 American Ca ncer Society.