Extreme Aggressiveness and Lethality of Gastric Adenocarcinoma in the Very Young

Objective: To determine whether very young patients with gastric adenocarcinoma as compared with older patients with the disease have a biologically more aggressive form of the disease, presenting at an advanced stage and conferring unusually poor perioperative and long-term outcomes. Design, Setting, and Patients: A 15-year, single-institution, retrospective review and analysis of demographic and outcomes data for 350 patients diagnosed with gastric adenocarcinoma. Main Outcome Measures: Histologic features, frequency of stage IV disease, frequency of curative gastric resection, postoperative mortality, and long-term survival in very young and older patient groups. Results: Of 350 total patients, 30 (9%) were aged 35 years or younger. Very young patients (aged <= 35 years) as compared with older patients (aged > 35 years) more often had diffuse-type tumor histologic findings (93% vs 69%, respectively; P=.003), adjacent organ invasion (74% vs 29%, respectively; P=.001), nodal metastases (94% vs 70%, respectively; P=.046), distant metastases (81% vs 50%, respectively; P=.003), and stage IV disease (90% vs 64%, respectively; P=.007). Potentially curative gastrectomy was accomplished in 58% of older patients but only 17% of very young patients (P=.001). Nontherapeutic operations were performed in only 6% of older patients but 33% of very young patients (P=.002). Very young patients as compared with older patients had high postoperative mortality (22% vs 2%, respectively; P=.003) related to advanced- stage disease. Mean survival was 33.4 months among older patients compared with only 11.6 months for very young patients (P=.02). Conclusions: Very young patients (aged <= 35 years) with gastric adenocarcinoma have significantly higher incidences of diffuse-type tumor histologic findings and both locally advanced and metastatic disease at presentation. These findings confirm a more aggressive tumor biology that results in often futile surgical interventions and an unusually grave prognosis. Strategies for earlier diagnosis together with effective new therapies are desperately needed to attenuate the extreme lethality in these uniquely unfortunate patients.