Gastric adenocarcinoma in young adult patients: patterns of care and survival in the United States
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Evidence regarding gastric cancer patients < 40 years old is limited. This study examines young adults with gastric adenocarcinoma in the National Cancer Database to describe demographics and treatment practices, and to develop a nomogram to predict survival.
The database was queried for adult patients diagnosed with gastric adenocarcinoma from 2004 to 2013. Patients were stratified into two age groups: <40 and ≥ 40 years. The database was analyzed to compare demographics, clinical characteristics, and treatments used for each group. Differences in survival were assessed using Kaplan–Meier curves and log-rank test. For adults < 40 years old, an accelerated failure time survival model was fitted for overall survival and a descriptive nomogram was constructed.
Of 70,084 patients included, 2615 (4%) were < 40 years old and 67,469 (96%) were ≥ 40 years. Compared to older patients, adults < 40 years old were more likely to be female (46 vs. 35%), non-white (31 vs. 23%), Hispanic (32 vs. 11%), from the northeast (36 vs. 23%), and to present with stage IV disease (59 vs. 42%) and bone metastases (36 vs. 21%; p < 0.001 for all). The nomogram showed clinical stage as the strongest predictor of overall survival, followed by treatment, grade, race, Charlson–Deyo comorbidity score, and sex.
Young adults with gastric adenocarcinoma are more likely to be Hispanic, female, from the northeast, and to present with metastases. Despite these differences, clinical stage, treatment, and tumor grade are most predictive of overall survival for young adult patients.
KeywordsGastric Young NCDB Adenocarcinoma
The authors wish to acknowledge the support of the Biostatistics Shared Resource Facility at Icahn School of Medicine at Mount Sinai and NCI Cancer Center Support Grant P30 CA196521-01. No other funding sources were used. The American College of Surgeon and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. For this type of study, formal consent is not required. This study was presented at the 2016 European Society of Medical Oncology Meeting in Copenhagen, Denmark.
Study concept and design: De and Ang. Administrative support: all authors. Provision of study materials: all authors. Collection and assembly of data: all authors. Data analysis and interpretation: all authors. Manuscript writing: De. Final approval of manuscript: all authors.
Compliance with ethical standards
Conflict of interest
Randall Holcombe reports personal fees from Anthem Healthcare and Merck, outside the submitted work, and also reports involvement in a colon cancer clinical trial as Chair of a Data Safety and Monitoring Committee, outside the submitted work. All other authors declare that they have no conflicts of interest.
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