title: Gastric adenocarcinoma in young patients: a population-based appraisal.
abstract: BACKGROUND
  Although international studies of young gastric cancer patients have mainly reported favorable survival outcomes compared with older patients, US-based experiences have shown a wider spectrum of outcomes. We examined the impact of young age (under 45 years) on the presentation and survival outcomes of gastric adenocarcinoma.
  
  
  METHODS
  A total of 33,236 patients with gastric adenocarcinoma were identified within the 1988-2006 Surveillance, Epidemiology, and End Results (SEER) registry. Multivariate regression analysis of relative survival was performed to adjust for covariate effects using generalized linear models.
  
  
  RESULTS
  Young patients were more likely than older patients to have advanced nodal and distant metastatic disease at presentation (P < 0.001 for both). Unadjusted relative survival analysis demonstrated younger patients to have favorable stage-stratified survival when compared with middle-aged and older patients. These findings persisted after adjusting for covariates. After stratifying for receipt of cancer-directed surgery, younger age was associated with more favorable stage-stratified relative survival.
  
  
  CONCLUSIONS
  This is the largest US population-based study of age-related gastric cancer outcomes. Although young patients with gastric cancer present with more advanced disease, their adjusted stage-stratified relative survival is more favorable than that of older patients. This study supports a stage-dependent treatment approach in younger populations.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Minnesota and Minneapolis Veteran Affairs Medical Center, Minneapolis, MN, USA. alref003@umn.edu
authors.forename: Waddah B
authors.initials: WB
authors.lastname: Al-Refaie
authors.forename: Chung-Yuan
authors.initials: CY
authors.lastname: Hu
authors.forename: Peter W T
authors.initials: PW
authors.lastname: Pisters
authors.forename: George J
authors.initials: GJ
authors.lastname: Chang
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000401:mortality* / Q000556:secondary; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018426:SEER Program; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000401:mortality* / Q000473:pathology; D015996:Survival Rate; D014481:United States / Q000453:epidemiology