|
|
Back to 2017 Posters
PRESENTATION, TREATMENT AND SURVIVAL OF YOUNGER PATIENTS WITH GASTRIC ADENOCARCINOMA: A NATIONAL CANCER DATA BASE (NCDB) STUDY
Maria C. Russell*2, Jeffrey Switchenko3, Natalyn N. Hawk4, Theresa W. Gillespie2, Saurabh Chawla1
1Digestive Diseases, Emory University School of Medicine, Atlanta, GA; 2Surgery, Emory University School of Medicine, Atlanta, GA; 3Rollins School of Public Health, Atlanta, GA; 4Hematology and Oncology, Emory University School of Medicine, Atlanta, GA
Presentation, treatment and survival of young patients (pts) with (GAC) is not well known. The aim of this study was to evaluate differences in survival in young pts with GAC and to determine clinical, pathologic and treatment variables that may impact overall survival (OS).
NCDB was used to identify pts diagnosed with GAC 2003-2012. After excluding in situ tumor, hormonal/immunotherapy and pts with other cancers, pts were split into age ≤ 40 years (yrs) and > 40 yrs and survival was assessed via Kaplan Meier curves. Univariate and multivariate analyses were then performed to evaluate for clinicopathologic and treatment variables that may influence survival.
Of the 212,634 patients in the Gastric PUF File, 112,789 met inclusion criteria (4901 in ≤40 yrs, 107,888 in >40 yrs). Median survival was 1.6yrs for ≤ 40, 1.2yrs for > 40 (p<0.0001). There was improved OS and stage for stage survival in younger pts (p< 0.0001).
On univariate analysis between ≤ 40 yr and > 40 yr groups, younger patients were more likely to be female (47.9%vs38.3%), white (68.6%vs76.1%), Hispanic (28.4%vs10.3%). They also differed on insurance status (14%vs4.2% uninsured, 59.8%vs34.2% private), highest quintile percent w/o high school diploma (27.3%vs21.6%) and had less co-morbidities [ Charlson-Deyo score of zero (87.7%vs69.7%)].
Comparing tumor characteristics and treatment received, in the < 40 group compared to > 40 group, the younger patients had more aggressive tumor characteristics [primary tumors (54.5%vs50.8% >4cm), higher grade(76.9%vs62.5% poorly diff), T4 tumor (30.3%vs21.14%), AJCC stage (60.5%vs46.1% Stage IV)]. They were also more likely to receive multimodality treatment (38.9%vs32.5%). On multivariate analysis improved OS was significantly associated with age ≤ 40, female gender, Asian or Hispanic ethnicity, private insurance, higer income, grade I tumor, and receipt of definitive surgery and/or multimodality therapy (all p<0.001).
Our study shows that gastric cancer pts ≤ 40 yrs have improved survival despite presentation with larger, higher grade and T4 tumors with more metastatic disease. These disparities in presentation and outcomes may be related to socioeconomic factors and/or a difference in tumor biology and genetics which should be further investigated.
Back to 2017 Posters
|
