Gastric cancer in young patients: Demographic, clinicopathological, and prognostic factors in 92 patients

Background: This investigation was undertaken to define the demographic, cl inicopathological, and prognostic factors relevant to young patients with g astric adenocarcinoma. Methods: A prospective database of all patients with gastric cancer who pre sented to Memorial Sloan-Kettering Cancer Center was started in 1985. Clini cal, pathological, and operative records and follow-up data on 92 patients, 40 years of age or younger, with a primary diagnosis of gastric cancer wer e reviewed. Results: The mean patient age was 35 +/- 4.9 years (range, 17-40 years), an d 52 were male. The male-to-female ratio of patients younger than 30 was 0. 85/1; whereas in those older than 30, the ratio was 1.45/1. Sixty-six perce nt of the patients were white, 15% Asian, 11% Hispanic, and 8% were black A merican. Nineteen percent of patients reported a family history of gastric cancer. Sixty-six patients (71%) presented with stage III or IV disease, wh ereas 13 patients, each, presented with stage I or II disease. Poorly diffe rentiated lesions were present in 71%. Resection with curative intent was u ndertaken in 47 patients, and resection with palliative intent was performe d in 24 patients. Tumor site (proximal vs. distal vs. linitus plastica), ad vanced T stage, and the presence of nodal disease were significant predicto rs of disease-free survival on both univariate and multivariate analyses. T he mean survival time and disease-specific 5-year survival rates for indivi dual Union International Contre le Cancer tumor stages were similar to thos e observed in older populations of patients with gastric cancer; and eight patients, who presented with early (T-1/T-2) node-negative tumors, are aliv e and well a minimum of 60 months after resection. Conclusions: The high frequency of a positive family history in young patie nts suggests an opportunity to identify a high-risk population for screenin g.