Early-onset gastric cancer is a distinct disease with worrisome trends and oncogenic features

John R. Bergquist, Jennifer L. Leiting, Elizabeth B. Habermann, Sean P. Cleary, Michael L. Kendrick, Rory L. Smoot, David M. Nagorney, Mark J. Truty, Travis E. Grotz

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: Overall the incidence of gastric cancer is declining in the United States; however, the incidence of early-onset gastric cancer is increasing. We sought to elucidate clinical and genomic characteristics and risk factors for early-onset gastric cancer compared with late-onset gastric cancer. Methods: We utilized the Surveillance, Epidemiology, and End Results database (1973–2015), the Behavioral Risk Factor Surveillance Survey, and The Cancer Genome Atlas to characterize early-onset gastric cancer. Results: The incidence of early-onset gastric cancer increased during the study period and now comprises >30% of all gastric cancer in the United States. Early-onset gastric cancer was associated with higher grade (55.2 vs 46.9%), signet-ring cells (19.0 vs 10.4%), diffuse histology (25.7 vs 15.0%), and metastatic disease (49.5 vs 40.9%, all P < .01) compared with late-onset gastric cancer. Early-onset gastric cancer was more likely to be Epstein-Barr virus (7.7 vs 5.1%) or genomically stable (22.5 vs 8.1%) subtype, whereas late-onset gastric cancer was more likely to be microsatellite instability subtype (18.6 vs 5.6%; all P < .01). Risk factors for gastric cancer were less correlated with early-onset gastric cancer compared with late-onset gastric cancer. Conclusion: The incidence of early-onset gastric cancer has been steadily increasing in the United States, comprising >30% of new gastric cancer cases today. Early-onset gastric cancer is genetically and clinically distinct from traditional gastric cancer. Additional investigations are warranted to better understand this alarming phenomenon.

Original languageEnglish (US)
Pages (from-to)547-555
Number of pages9
JournalSurgery (United States)
Volume166
Issue number4
DOIs
StatePublished - Oct 2019

ASJC Scopus subject areas

  • Surgery

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