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.
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Article info
Publication history
Published online: December 11, 2018
Accepted:
November 5,
2018
Received in revised form:
November 5,
2018
Received:
October 5,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
