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Surgery. 2019 Apr;165(4):802-807. doi: 10.1016/j.surg.2018.11.001. Epub 2018 Dec 11.

Effect of age on the clinical outcomes of patients with early gastric cancer with undifferentiated-type histology.

Author information

1
Center for Health Promotion, Samsung Medical Center, Seoul, Korea.
2
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: leehyuk@skku.edu.
3
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
4
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
5
Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea.
6
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

BACKGROUND:

Undifferentiated-type early gastric cancers account for a large proportion of gastric cancers in younger patients. Therefore, the clinical outcomes of endoscopic resection in younger patients are a major concern. We aimed to investigate the influence of age on lymph node metastasis and long-term survival after surgery for undifferentiated-type early gastric cancers.

METHODS:

We identified 4,236 patients who underwent surgery for undifferentiated-type early gastric cancers. For each T stage, the correlation between age and lymph node metastasis was analyzed using a multivariate logistic regression. Lymph node metastasis rates were compared between younger (<40 years) and older patients (≥40 years) who fulfilled the expanded criteria for endoscopic resection. The Kaplan-Meier method was used to compare long-term survival between younger and older patients.

RESULTS:

Younger age groups (20-29 and 30-39 years) had the highest lymph node metastasis rate within each T stage (5.7% and 5.7% for T1a, 26.3% and 24.1% for T1b, respectively). After adjusting for possible covariates, however, age did not have a significant effect on lymph node metastasis in either T stage (P = .127 for T1a, P = .114 for T1b). Among patients fulfilling the expanded indication for endoscopic resection, younger patients had a slightly higher lymph node metastasis rate compared with older patients (2.7% versus 2.0%), although this difference was not statistically significant. Although younger patients had a significantly better overall survival (P < .001), no significant age-related differences were observed in recurrence-free and disease-specific survival (P = .051 and P = .069) CONCLUSION: Endoscopic resection may be feasible in young patients with undifferentiated-type early gastric cancers because these patients share a similar lymph node metastasis rate and long-term survival outcomes with older patients.

PMID:
30551867
DOI:
10.1016/j.surg.2018.11.001

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