Gastric Carcinomas in Young (Younger than 40 Years) Chinese Patients

Zhang, Fan; Shi, Jiong; Fang, Cheng; Zou, Xiaoping; Huang, Qin

doi:10.1097/md.0000000000002873

Cited by 39 publications

(40 citation statements)

References 46 publications

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“…A small number of larger analyses have been conducted but have limited or no data from the last 10 years [4,10,34]. Several findings regarding patient presentation in this hospital-based analysis are consistent with past reports, including higher rates of female sex, non-white race, signetring or diffuse histology, advanced clinical stage disease, higher grade, advanced T-stage, and nodal involvement [4][5][6][7][8][9][10][11][12][13]. Among young adult patients, findings that have not been previously reported including a larger proportion of patients treated in metropolitan areas, in the northeast, at facilities in the top decile of gastric cancer patient volume, and with private, Medicaid, or no insurance and higher frequency of bone metastases.…”

Section: Discussionsupporting

confidence: 81%

“…Though young adults are less commonly affected by gastric cancer, there have been mixed reports about the prognosis of younger patients from studies around the world. Some have suggested that young patients more often have diffuse-type and signet-ring histologies, higher stage disease, more frequent nodal involvement, and higher postoperative mortality [4][5][6][7][8][9][10][11]; and others have explored the idea of gastric cancer in the young as a different clinical entity, raising questions for the role of differential management [12,13]. Most studies are reports from single institutions or use the Surveillance, Epidemiology, and End Results (SEER) database, which lacks detailed treatment data unless combined with data from the Medicare-linked database.…”

Section: Introductionmentioning

confidence: 99%

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Gastric adenocarcinoma in young adult patients: patterns of care and survival in the United States

Rhome

Jairam

et al. 2018

Gastric Cancer

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Gastric adenocarcinoma in young adult patients: patterns of care and survival in the United States

Rhome

Jairam

et al. 2018

Gastric Cancer

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“…The definition of young age varies among studies, but most research would define it as being younger than 40 years of age. [ 7 , 8 ] Reports have shown an increasing trend of GC in younger patients, [ 9 , 10 ] and the clinicopathological features in this group of patients showed more diffuse lesions and advanced tumor stage compared with older GC counterparts, although whether this translates into worse prognosis in this group remains controversial. [ 11 , 12 ]…”

Section: Introductionmentioning

confidence: 98%

Risk factors for lymph node metastasis of early gastric cancers in patients younger than 40

Zhang

Wang

et al. 2017

Medicine

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This research aims to explore the potential risk factors of lymph node metastasis (LNM) for early gastric cancers in young patients.We retrospectively collected data from 4287 patients who underwent gastrectomy from January 2005 to December 2015 at Linyi People's Hospital. Of these, we enrolled 397 eligible consecutive patients who had early gastric cancer, then divided them into 2 groups according to age (≤40 years and >40 years). The association between the clinicopathological factors and LNM was analyzed by univariate and multivariate analysis.Compared to older patients (>40 years), younger patients (≤40 years) with early gastric cancer had more diffuse and mixed types (51.1% and 37.8% vs 40% and 8.3%, respectively), less proximal gastric cancer (0% vs 33.8%, P < .01) and higher LNM (33.3% vs 13%, P < .01). Univariate analysis showed tumor invasion depth (P < .01), lymphovascular invasion (P < .01), and E-cadherin expression (P = .024) were associated with LNM in the younger cohort. Multivariate analysis revealed that lymphovascular invasion (OR = 17.740, 95% CI: 1.458–215.843) was an independent risk factor for LNM (P = .024). Further analysis showed 3 patients who were within expanded endoscopic resection indications were positive for LNM.Given the high risk of lymph node involvement in young patients with early gastric cancer, both endoscopic and surgical resection procedures should be performed with caution, and active postoperative surveillance is warranted.

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“…The high diversity and plasticity of gastric epithelial stem cells is responsible for 2 major groups of EGC: proximal cardiac carcinoma and distal noncardiac carcinoma with different epidemiology, pathology, clinical presentation, and prognosis [10]. On the other hand, the hereditary form of early-onset gastric carcinoma is associated with dysregulated gastric stem cells, which occur mainly in the corpus-fundic regions through the CDH-1 gene mutation-related and -unrelated unknown mechanisms [11,12]. …”

Section: Heterogeneity Of Gastric Epithelial and Stem Cellsmentioning

confidence: 99%

“…the lesser curvature side of the antrum-angularis in patients in 60 years and the cardia for male patients over 40 years. For young women with the family history and clinical suspicion for gastric carcinoma, the corpus and fundus, especially, near the greater curvature, are the most vulnerable regions for early-onset carcinoma [11,12,13]. …”

Section: Gastric Regions At High Risk For Early Carcinomamentioning

confidence: 99%

Clinicopathology of Early Gastric Carcinoma: An Update for Pathologists and Gastroenterologists

Huang¹,

Zou

2016

Gastrointest Tumors

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Background: The WHO defines early gastric carcinoma (EGC) as invasive carcinoma up to the submucosal layer, regardless of nodal metastasis. The recent study results indicate that EGC varies in location, histology, nodal metastasis, and prognosis. Summary: The heterogeneity in EGC may be related to various types of epithelial stem cells. The most important stem cells include Lgr5⁺ cells at the base of a gastric unit in the antrum-pylorus-cardia, Mist1⁺ cells at the isthmus/Troy⁺ cells at the base in the corpus-fundus, and Sox2⁺ cells at the base in almost all regions. Dysregulation of these cells along with environmental factors transform stem cells in different regions into malignancy in genetically susceptible populations. Key Message: The 2 most vulnerable regions for EGC have been found along the lesser curvature: the cardia in elderly patients and antrum-angularis in mid-aged and elderly patients. Most hereditary early-onset gastric carcinomas are concentrated in the corpus-fundus of young women. By histology, the most common EGC type is tubular adenocarcinoma in many growth patterns, starting in the neck of a gastric unit. Worse prognosis has been found in early papillary, compared to tubular, adenocarcinoma, related to deeper penetration, more lymphovascular invasion, and more liver and nodal metastases. Contrary to the common belief, intramucosal signet ring cell carcinoma demonstrates low risk of nodal metastasis, comparable to early intestinal-type EGC. Practical Implications: The overall risk for nodal metastasis in EGC is low but significant. It is urgent to organize multicenter studies on risk of nodal metastasis in EGC in order to establish more reliable clinical practice guidelines to treat EGC patients.

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Gastric Carcinomas in Young (Younger than 40 Years) Chinese Patients

Abstract: Supplemental Digital Content is available in the text

Cited by 39 publications

References 46 publications

Gastric adenocarcinoma in young adult patients: patterns of care and survival in the United States

Gastric adenocarcinoma in young adult patients: patterns of care and survival in the United States

Risk factors for lymph node metastasis of early gastric cancers in patients younger than 40

Clinicopathology of Early Gastric Carcinoma: An Update for Pathologists and Gastroenterologists

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