Trends, clinicopathological features, surgical treatment patterns and prognoses of early-onset versus late-onset gastric cancer: A retrospective cohort study on 18877 patients

BackgroundThe trend changes and clinical-pathological characteristics between early-onset gastric carcinoma (EOGC) and late-onset gastric carcinoma (LOGC) need clarification.MethodsThe study population includes 18,877 cases from Fudan University Shanghai Cancer Center (FUSCC) between 2000 and 2022. Statistical analysis utilized IBM SPSS for descriptive statistics, survival analysis using the Kaplan-Meier method and log-rank test, and COX regression analysis to identify factors influencing disease-free survival (DFS) and overall survival (OS).ResultsSince the beginning of the 21st century, there has been a slight increase in the average age of diagnosis for gastric cancer patients, accompanied by a steady rise in the number of cases for both EOGC and LOGC, albeit with a slight decrease in the proportion of EOGC cases. Compared to the LOGC group, the EOGC group exhibited a higher proportion of females and tended to occur in the gastric body and antrum pylorus. EOGC cases showed lower levels of cancer-related biomarkers, HER2 expression, vascular and lymphatic invasion, lower differentiation and invasion depth, more advanced N staging and TNM staging, Borrmann IV type, and low adhesive carcinoma (including signet ring cell carcinoma and its variants), along with more extensive D2 lymphadenectomy and neoadjuvant chemotherapy. Furthermore, there were no significant differences observed between the two groups regarding the status of Claudin18.2 and MMR (Mismatch Repair) proteins. Additionally, EOGC cases had a higher incidence of ovarian and peritoneal metastases. Early prognosis for EOGC was superior to that for LOGC, although late-stage progression was more rapid.ConclusionsThe numbers of EOGC and LOGC cases have continuously increased over the last two decades. EOGC cases demonstrated distinct clinical, pathological, and treatment characteristics, including lower cancer-related biomarkers, more advanced staging, more thorough curative surgical treatment, and better early prognosis but faster late-stage progression. Increased screening programs targeting younger adults are recommended to address the rising trend of EOGC effectively.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.