Objective: To clarify the clinicopathological features, prognosis, and recurrence pattern of early-onset gastric cancer (EOGC). Methods: Using data from the gastric cancer database of Zhongshan Hospital, Fudan University, we performed a retrospective, large-scale, real-world study of 5046 patients with gastric cancer who had undergone redical or palliative gastrectomy from January 2013 to December 2018, including 425 patients with EOGC (age ≤45 years) and 4621 controls. All those patients were pathologically confirmed adenocarcinoma with complete follow-up of five years. Residue gastric cancer and patients without complete clinical or follow-up data were excluded. We used a combination of outpatient and telephone follow-up, ending in October 2022 (median duration of follow-up 60 months), and compared the clinicopathological features and prognosis of the two groups. Results: The clinicopathological features of EOGC included female predominance (61.1% [262/425 vs. 26.3% [1217/4621], χ2=234.215, P<0.001), fewer comorbidities (31.3% [133/425] vs. 58.5% [2703/4621], χ2=34.378, P<0.001), poorer differentiation (90.6% [385/425] vs. 78.2% [3614/4621], χ2=30.642, P<0.001), higher proportion of diffuse type (53.9% [229/425] vs. 18.3% [846/4621], χ2=274.474, P<0.001), higher proportion of T4 stage (44.7% [190/425] vs. 37.5% [1733/4621], χ2=17.535, P=0.001), more lymph node metastases (60.5% [257/425] vs. 53.9% [2491/4621], χ2=6.764, P=0.009), and higher proportion of pathological stage III/IV (47.5% [202/425] vs. 42.4% [1959/4621], χ2=4.093, P=0.043). The 5-year overall survival rates of the EOGC and control groups were 55.1% and 49.1%, respectively. Overall survival was significantly better in the EOGC than in the control group (P<0.001). According to subgroup analysis, the prognosis of pathological stage I/II/III EOGC was better than that of the control group. Recurrence rates were similar in the two groups, whereas patients with EOGC had a higher proportion of peritoneal recurrence (7.8% [33/425] vs. 3.2% [146/4621], χ2=23.741, P<0.001) and a lower proportion of distant metastasis (4.9% [21/425] vs. 8.3% [385/4621], χ2=6.247, P=0.012). Conclusion: EOGC has unique clinicopathological features and recurrence patterns and resectable EOGC has a better prognosis, suggesting that patients with EOGC should be actively treated with the focus on preventing peritoneal recurrence.
目的： 探索早发性胃癌（EOGC）临床病理特征、复发模式及生存预后。 方法： 本研究为回顾性真实世界大数据研究，采用观察性研究方法。基于复旦大学附属中山医院胃癌专病数据库，纳入2013年1月至2018年12月期间于复旦大学附属中山医院行胃切除术（根治性胃切除和姑息性胃切除）、经术后病理明确为胃腺癌且完成5年随访的患者，排除残胃癌和资料不完整者，共5 046例胃癌患者纳入分析。将年龄≤45岁者定义为EOGC组（425例），非EOGC组4 621例。采用门诊及电话随访结合的方式，随访截止至2022年10月，中位随访时间60个月。比较两组临床特征及生存预后。 结果： 与非EOGC组患者比较，EOGC组患者以女性为主［61.6%（262/425）比26.3%（1 217/4 621），χ2=234.215，P<0.001］，合并症较少［31.3%（133/425）比58.5%（2 703/4 621），χ2=34.378，P<0.001］，低-未分化比例更高［90.6%（385/425）比78.2%（3 614/4 621），χ2=30.642，P<0.001］，Lauren分型的弥漫型比例高［53.9%（229/425）比18.3%（846/4 621），χ2=274.474，P<0.001］，T4分期比例高［44.7%（190/425）比37.5%（1 733/4 621），χ2=17.535，P=0.001］，淋巴结转移比例高［60.5%（257/425）比53.9%（2 491/4 621），χ2=6.764，P=0.009］，病理分期Ⅲ~Ⅳ期比例高［47.5%（202/425）比42.4%（1 959/4 621），χ2=4.093，P=0.043］；差异均有统计学意义（均P<0.05）。EOGC组与非EOGC组的5年总生存率分别为55.1%和49.1%，EOGC组患者总生存率显著优于非EOGC组（P<0.001）。亚组分析显示，病理分期Ⅰ~Ⅲ期EOGC患者的总生存率均优于非EOGC患者，差异有统计学意义（均P<0.05）；而两组的Ⅳ期总生存差异无统计学意义（P=0.430）。复发转移模式分析显示，EOGC组腹膜复发比例高［7.8%（33/425）比3.2%（146/4 621），χ2=23.741，P<0.001］，而远处转移比例则相对较低［4.9%（21/425）比8.3%（385/4 621），χ2=6.247，P=0.012］。 结论： EOGC具有独特的临床病理特征和复发模式，可根治性切除的EOGC预后更好，提示对EOGC应积极治疗干预并注重预防腹膜复发。.