Clinical and Molecular Characteristics of Early-Onset versus Average-Onset Esophagogastric Cancer
Menée à partir de données portant sur 2 027 patients atteints d'un cancer gastro-oesophagien traité entre 2005 et 2018, cette étude analyse les caractéristiques cliniques et moléculaires de la maladie en fonction de l'âge au diagnostic (moins de 50 ans, 50 ans ou plus)
Purpose : The rate of esophagogastric cancer (EGC) is rising among individuals under the age of 50. It remains unknown whether early onset (EO)-EGC represents a unique entity. This study investigates the clinical and molecular characteristics of EO- and average onset (AO)-EGC.
Methods : We reviewed the Memorial Sloan Kettering Cancer Center gastric, esophageal and gastroesophageal junction (GEJ) cancer database. Associations between baseline characteristics and tumor and germline molecular alterations were compared between those with EO- and AO-EGC using Fisher’s exact test, and the Benjamini-Hochberg method for multiple hypothesis correction.
Results : We included 1123 patients with EO-EGC (n = 219, median age 43, range 18-49 years) and AO-EGC (n = 904, median age 67, range 50-94 years) treated between 2005 and 2018. The EO group had more females (39% vs 28%, p = .002). Patients with EO-EGC were more likely to have a gastric primary site (64% vs 44%, p < .0001). The signet ring cell/diffuse type was three-times more common in the EO-EGC group (31% vs 9%, p < .0001). EO tumors were more frequently genomically stable (31% vs 18%, p = .0002) and unlikely to be microsatellite-instability-high (2% vs 7%, p = .003). After restricting to adenocarcinoma and signet ring cell/diffuse type carcinomas, we observed no difference in stage (p = 0. 394) or overall survival from stage IV diagnosis (median 22.7 vs 22.1 months, p = .78).
Conclusions : Our study supports a preponderance of gastric primary disease site, signet ring histology and genomically stable molecular subtype in EO-EGC. This highlights the need for further research to define the underlying pathogenesis and strategies for early detection and prevention.
Journal of the National Cancer Institute , résumé, 2022