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ESMO World GI 2019: Incidence of Gastric Cancer in Younger Individuals

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Key Points

  • Data from 2,022 patients with gastric adenocarcinoma diagnosed between 2004 and 2016 was analyzed. Two hundred and ninety patients (14%) were under 40. Of these, 54% were women and 46% were men.
  • Women had higher poor prognostic factors than men, including more instances of diffuse-type tumors, ring-seal cells, and poorly differentiated disease, as well as a higher prevalence of stage IV disease.
  • Median overall survival was 7 vs 8 months for women and men and was worse in patients with gastroesophageal junction tumors and more advanced disease.

The incidence of gastric cancer has been increasing in younger individuals, and those under 40 with chronic digestive symptoms should be more actively investigated. These findings follow new data from a retrospective, observational study in Mexico, which showed that 1 in 7 of over 2,000 patients diagnosed with gastric cancer between 2004 and 2016 were under 40. These findings from a study, reported by Calderillo-Ruiz et al at the European Society for Medical Oncology (ESMO) World Congress on Gastrointestinal Cancer 2019 (Abstract P-145), support U.S. National Cancer Institute data showing an increase in the incidence of gastric cancer in the younger population.

“At our center, we have seen a 120% increase in gastric cancer in younger patients in the last 12 years, and this increase has been mainly in female patients who typically present with more advanced disease and worse prognostic indicators than men, with an adverse impact on survival,” said first study author Germán Calderillo-Ruiz, MD, of the National Cancer Institute, Tlalpan, Mexico.

Study Findings

In the Mexican study, data from 2,022 patients with gastric adenocarcinoma diagnosed between 2004 and 2016 were analyzed. A total of 290  patients (14%) were under 40. Of these, 54% were women and 46% were men.

Women had higher poor prognostic factors than men, including more instances of diffuse-type tumors (68% vs 32%, respectively; P = .127), ring-seal cells (76% vs 69%; P = .049), and poorly differentiated disease (89% vs 84%; P = .014), as well as a higher prevalence of stage IV disease (59% vs 41%; P = .011).

Median overall survival was 7 vs 8 months for women and men, respectively (hazard ratio [HR] = 1.29, 95% confidence interval [CI] = 1.05–1.65; P = .03). Median overall survival was significantly worse in patients with gastroesophageal junction tumors (7 vs 14 months [HR = 0.68, 95% CI = 1.05–2.688; P = .23]) and more advanced disease (clinical stages I–III, locally advanced, and stage IV: 33, 12, and 5 months, respectively [HR = 2.28, 95% CI = 1.72–3.01; P = .001]). Independent predictors of overall survival were maintained in a Cox-Regression analysis: gender (HR = 1.29, 95% CI = 1.01–1.65; P = .038), primary tumor (HR = 1.68, 95% CI = 1.05–2.68; P = .02), and clinical stage (HR = 2.28, 95% CI = 1.72-3.01; P = .001).

Commentary

“The lack of financial resources may impact … women’s behavior of delaying pursuit of medical care when gastric symptoms appear. We hope this research will encourage clinicians and patients to be more aware of the risk of gastric cancer in younger people and, in particular, to encourage women with gastric symptoms to seek medical help sooner,” said Dr. Calderillo-Ruiz.

Commenting on the implications of the research, Rodrigo Dienstmann, MD, of Vall d’Hebron Institute of Oncology, highlighted the combination of genetic and environmental factors that contribute to gastric cancer and the fact that young people with gastric cancer have more aggressive disease that is less responsive to curative treatment. “We cannot change the genetic factors, but we can act on the unhealthy diet, obesity, and untreated Helicobacter pylori infection, which increase the risk of gastric cancer. Helicobacter infection can cause chronic inflammation and lesions that are precursors to gastric cancer, but once diagnosed, can be cured with a combination of antibiotics and drugs to reduce stomach acid,” said Dr. Dienstmann.

“Younger people who regularly experience indigestion, heartburn, or other gastric symptoms should not ignore them but should go to their doctor, as they probably need diagnostic tests. In addition, clinicians should not ignore the possibility of gastric cancer in the younger population, particularly in Latin America or among Hispanics in North America.” he concluded. Following the latest research in Mexico, epidemiologic and molecular studies are being conducted in Latin America and Europe to investigate the different molecular subtypes of gastric cancer in the regions and improve our understanding of risk factors in these populations.

Disclosure: For full disclosures of the study authors, visit academic.oup.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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