Incidence and long-term outcome of young patients with gastric carcinoma according to sex: Does hormonal status affect prognosis?

Background: We investigated the clinicopathological features and evaluated the prognostic impact of age and sex on patients with gastric cancer. Design: Retrospective study from 1993 to 2000. Setting: Korea University Medical Center. Patients: A total of 1299 patients with gastric cancer were divided into young (n = 175 [13.5%]) and older (n = 1124 [86.5%]) groups with an age cutoff of 40 years. Main Outcome Measures: Clinicopathological characteristics were investigated and survival analysis was performed according to sex for each age group. Results: Tumor differentiation was significantly different between the 2 age groups. Among male patients, the young group had more undifferentiated tumors than the older group (P < .001) but, in female patients, both differentiation (P < .001) and operative methods (P = .008) were significantly different between the young and older groups. In male patients, the 10-year survival rate of the young group was higher (62.5%) than that of the older group (44.6%) (P = .03). Although it was not statistically significant, the survival rate of the older female group was higher than that of the young group (56.2% vs 51.9%). On multivariate analysis, tumor stage (P < .001) and sex (P = .042) were proved to be independent prognostic factors. Conclusions: Only tumor differentiation was an important difference between the 2 age groups, and prognosis was not affected by age. However, when sex was added to age as a factor, the older male and young female groups had an unfavorable prognosis. Therefore, we propose that sex hormones such as estrogens contribute to the survival differences, and further studies are needed to confirm this possibility.