NEW YORK (Reuters Health) Jun 25 - Patients aged 35 years or less with gastric adenocarcinomas appear particularly at risk of having advanced disease at diagnosis, as well as more aggressive tumors, Californian researchers report in the June issue of the Archives of Surgery.
Dr. Bruce E. Stabile of University of California, Los Angeles, Medical Center, Torrance, and Dr. Brian R. Smith of the University of California, Irvine Medical Center, Orange point out that clinical observation has suggested that very young patients have a far worse prognosis than their older counterparts. "The relatively high mortality is largely attributable to the advanced stage of disease at diagnosis regardless of age," they note.
To investigate whether they also had biologically more aggressive disease, the researchers retrospectively reviewed data on 350 patients diagnosed with the condition.
In all, 30 (9%) were aged 35 years or less, and compared to older patients, they were significantly more likely to have histologic findings of diffuse tumor types (93% versus 69%). This was also true of adjacent organ invasion (74% versus 29%) as well as nodal and distant metastases. They were also more likely to have stage IV disease (90% versus 64%).
Despite similar operation rates, potentially curative gastrectomy was achieved in only 17% of the younger patients compared to 58% of older patients. The younger patients also had higher postoperative mortality (22% versus 2%).
In addition, mean survival was 33.4 months in older patients compared to 11.6 months in younger patients.
Given these findings, the researchers conclude that "strategies for earlier diagnosis together with effective new therapies are desperately needed to attenuate the extreme lethality in these uniquely unfortunate patients."
Arch Surg 2009;144:506-510.
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