Adolescents and Young Adults at Increased Risk for Gastric Cancer Death

Compared with middle-aged and older adults, adolescents and young adults have a higher risk for gastric cancer-related death but a lower risk for all-cause death.

Adolescents and young adults have a higher risk for gastric cancer-specific death compared with middle-aged and older adult patients with gastric cancer, according to study findings in the Journal of Gastroenterology and Hepatology.

Researchers conducted a retrospective cohort study to assess the incidence rate, death rate, and prognostic factors in the overall survival and cancer-specific survival of adolescents and young adults with gastric cancer. 

A total of 133,603 patient records were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Researchers analyzed all patients diagnosed with gastric cancer from 1975 to 2015 according to the International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) codes. 

The study population included patients aged 15 years and older with 1 primary tumor, complete survival and pathological data, and a record of the age at diagnosis.

More attention should be given to AYAs [adolescents and young adults], and chemotherapy and intraoperative radiation should be cautiously used for AYAs [adolescents and young adults].

The adolescent and young adult group was defined by a diagnosis of gastric cancer at 15 to 39 years. The middle-aged to older adult patient group was characterized by a diagnosis at 40 years and older. Cancer-specific survival was defined as the time from diagnosis to the time of gastric cancer-related death. 

There were 100,844 patients included in the final analysis, with 3606 records from adolescents and young adults and 97,238 records from middle-aged and older adult patients.

The gastric cancer incidence rate trend increased from 1970 to 2015 among adolescents and young adults (average annual percent change [AAPC], 0.2; 95% CI, -0.2 to 0.6), while the rate trend among middle-aged and older adult patients showed a significant decrease (AAPC value of -1.7 (95% CI, -1.8 to -1.6).

The gastric cancer all-cause death rate showed a decrease from 1975 to 2015 among adolescents and young adults (AAPC, -0.6; 95% CI, -0.8 to -0.5) and middle-aged and older adult patients (AAPC, -0.5; 95% CI, -0.6 to -0.4). 

Cumulative plots revealed that adolescents and young adults had a lower risk for all-cause death (hazard ratio [HR], 0.87; 95% CI, 0.84-0.9) but an increased risk for gastric cancer-specific death compared with middle-aged and older adult patients (HR, 1.11; 95% CI, 1.07-1.15).

Some factors for worse overall survival in middle-aged and older adult patients were sex (HR, 1.08; 95% CI, 1.07-1.1), age (HR, 1.02; 95% CI, 1.02-1.02), the primary site at overlapping lesion of the stomach (HR, 1.17; 95%CI, 1.14-1.21), grade II (HR, 1.24; 95% CI, 1.2-1.29) and mucinous carcinoma (HR, 1.1; 95% CI, 1.06-1.14). There were similar trends for cancer-specific survival in this population. 

For adolescents and young adults, chemotherapy was a notable risk factor for overall survival (HR, 1.27; 95% CI, 1.16-1.4), and intraoperative radiation worsened cancer-specific survival (HR, 2.89; 95% CI, 1.13-7.37).

Study limitations include missing data and a lack of chemotherapy regimen information. 

“Chemotherapy and intraoperative radiation were risk factors for worse OS [overall survival] and CSS [cancer-specific survival] in AYAs [adolescents and young adults], respectively,” the study authors noted. “Our findings suggested that more attention should be given to AYAs [adolescents and young adults], and chemotherapy and intraoperative radiation should be cautiously used for AYAs [adolescents and young adults].”

References:

Wen J, Shen H. Trend of gastric cancer incidence and death rate in adolescents and young adults: a retrospective cohort study based on the Surveillance, Epidemiology, and End Results (SEER) database. J Gastroenterol Hepatol. November 20, 2022. doi: 10.1111/jgh.16064