Treatment decisions in adolescents and young adults with gastric cancer in North Estonia Medical Centre from 2007-2016

Abstract

Introduction: According to the Estonian National Cancer Registry, approximately 400 new GC cases are diagnosed in Estonia annually, among them 18 patients under the age of 45 years. The present study aimed to characterize the diagnosis and treatment of GC in young Estonian patients. The current work is a single institution experience of the last 10-year data from 2007 to 2016. Method(s): This is a retrospective cohort study from the North Estonia Medical Centre newly diagnosed with gastric adenocarcinoma. PFS and OS were calculated as time from initial histological diagnosis until progression evaluated by CT or last contact, date of death retrieved from Estonian Causes of Death Registry or date of cutoff for analysis (1 August 2017), respectively. Result(s): 74 young patients diagnosed with GC were included in the current study, median age at diagnosis was 39 years (range: 19-45), the male to female ratio 1.13:1 (41 male, 33 female). 66% of patients (n=49) had signet-cell carcinoma and 66% were grade 3 cancers. In total, 35 radical surgeries and 19 diagnostic laparoscopies were performed. 26 patients (74%) had total gastrectomy, 8 patients (23%) subtotal gastrectomy. 10 splenectomies were performed, of these two resections due to intraoperative trauma, and seven for greater curvature cancers. Cholecystectomy was performed in almost half of the surgeries (n=17). Out of 35 resections, the histology results were not concordant in 31% of cases compared with the initial diagnostic biopsies. 50% of the patients were primarily diagnosed with stage IV disease, 15% had locoregionally advanced disease (stage III), 13% of the patients had stage II, 18% stage I. Extent of the primary tumors based on T-status at diagnosis was high, with 69% of patients diagnosed with T3 or T4 tumors. 50% of patients were considered node negative or with N1 disease at diagnosis. 28 patients were diagnosed with stage IB-IIIB GC, but only 54% (n=15) of patients received neoadjuvant chemotherapy and 25% (n=7) of patients received adjuvant treatment. 21% (n=6) of patients with an indication for perioperative chemotherapy did not receive any treatment. Altogether 42 patients received first line and 20 patients second line palliative chemotherapy, the mean number of cycles administered was 4.95 (range: 1-16 cycles) and 2.85 respectively. 5-year OS for all stages combined is 34.5%. OS for 44 patients died was 493 days (16.3 months). OS for stage IV patients at diagnosis who had died during the study period (n=33) was 306 days (10.0 months). Conclusion(s): The current study demonstrated a decline in GC in Estonian population among AYAs from previously reported 6% to 4.5%. GC had been histologically proven for all 74 cases but the discrepancy of histology results between biopsies obtained during endoscopy and during surgery was 31%. 21% of patients with indication did not receive perioperative chemotherapy. The reported 5-year OS of 34.5% is consistent with the median survival data of European AYAs with GC and exceeds Estonian GC survival across all age groups.