Korean J Gastroenterol.  2019 Nov;74(5):281-290. 10.4166/kjg.2019.74.5.281.

Clinicopathological Characteristics of Asymptomatic Young Patients with Gastric Cancer Detected during a Health Checkup

• Moon HH
• Kang HW
• Koh SJ
• Kim JW
• Shin CM

• KMID: 2464187
• DOI: http://doi.org/10.4166/kjg.2019.74.5.281

Abstract

BACKGROUND/AIMS
The Korean National Cancer Screening Program recommends biennial gastric cancer screening for patients aged ≥40 years. This study compared the characteristics of asymptomatic young gastric cancer patients aged <40 years, whose cancer was detected during a health checkup (screening group), with those whose disease was detected because of symptoms (diagnostic group).
METHODS
Data were collected retrospectively from 84 subjects who underwent a gastroduodenoscopy before the age of 40 years and who were diagnosed with gastric cancer from January 2006 to February 2017 in three tertiary centers in Korea. The clinicopathological characteristics, including age, sex, stage, location, pathology, and survival, were compared according to the purpose of endoscopy (screening group, n=23 vs. diagnostic group, n=61).
RESULTS
The median age of the screening group was higher than that of the diagnostic group (37 vs. 35 years, p=0.027), as was the proportion of early gastric cancer cases (78.3% vs. 29.5%, p<0.01), curative endoscopic treatment or operation rate (95.7% vs. 52.5%, p<0.01), and the overall survival (p<0.01). Poorly differentiated or signet ring cell carcinoma was less common in the screening group than in the diagnostic group (56.5% vs. 83.6%, p=0.006). The sex ratio, smoking status, family history of gastric cancer, Helicobacter pylori infection status, and tumor location were similar in the two groups.
CONCLUSIONS
Screening gastroduodenoscopy may enable the early detection of gastric cancer and prolong survival in patients <40 years of age.

Keyword

Gastric cancer; Screening; Endoscopy; Young adult

MeSH Terms

Carcinoma, Signet Ring Cell
Early Detection of Cancer
Endoscopy
Helicobacter pylori
Humans
Korea
Mass Screening
Pathology
Retrospective Studies
Sex Ratio
Smoke
Smoking
Stomach Neoplasms*
Young Adult
Smoke

Figure

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  Fig. 1 Flow chart of patient selection. *Means the purpose of endoscopy. F/U, follow up.

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  Fig. 2 Distribution of the patient's ages study population. Median age was 38 (range 21 to 39). Forty-eight (57.1%) gastric cancer cases were detected in patients with ages ranging from 35 to 39 years. Twenty-two (26.2%) cases were detected in those from 30 to 34 years and 14 (16.7%) cases were detected in those younger than 30 years of age. All of the 14 patients diagnosed with gastric cancer under the age of 30 years were in the diagnostic group.

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  Fig. 3 Kaplan-Meier survival curve between the two groups. Kaplan-Meier curves illustrating the overall survival of the screening and diagnostic groups. Among the patients in the diagnostic group, there were no deaths. A total of 23 deaths occurred in the diagnostic group. Overall the survival was significantly higher in the screening group than in the diagnostic group.

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