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J Cancer 2020; 11(3):678-685. doi:10.7150/jca.37531 This issue Cite

Research Paper

Young age increases risk for lymph node positivity in gastric cancer: A Chinese multi-institutional database and US SEER database study

Yuming Jiang^1*, Weicai Huang^1*, Jingjing Xie^2*, Zhen Han¹, Chuanli Chen³, Sujuan Xi⁴, Zepang Sun¹, Yanfeng Hu¹, Liying Zhao¹, Jiang Yu¹, Tuanjie Li¹, Zhiwei Zhou^5,6✉, Shirong Cai^7✉, Guoxin Li^1✉

1. Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China;
2. Center for Drug and Clinical Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;
3. Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838, Guangzhou Avenue North, 510515 Guangzhou, China;
4. Guangdong Key Laboratory of Liver Disease Research, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China;
5. Department of Gastric Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, P. R. China, 510060;
6. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China, 510060;
7. Department of Gastrointestinal Surgery of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510700, Guangdong, China.
*Yuming Jiang, Weicai Huang, and Jingjing Xie contributed equally to this work.

✉ Corresponding authors: Guoxin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China; Tel and Fax: +86-20-6278 7170; E-mail: gzliguoxincom. Shirong Cai, department of Gastrointestinal Surgery of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510700, Guangdong, China. E-mail: caishirongnet. Zhiwei Zhou, Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China; E-mail: zhouzhworg.cn. More

Abstract

Object: The risk of lymph node positivity (LN+) in gastric cancer (GC) impacts therapeutic recommendations. The aim of this study was to quantify the effect of younger age on LN+.

Methods: Data from a Chinese multi-institutional database and the US SEER database on stage I to III resected GC were analyzed for the relationship between age and LN+ status. The association of age and LN+ status was examined with logistic regression separately for each T stage, adjusting for multiple covariates. Poisson regression was used to evaluate age and number of LN+.

Results: 4,905 and 14,877 patients were identified in the China and SEER datasets respectively. 479 (9.8%) patients were under age 40 years, with 768 (15.7%) between age 40 and 49 years in China dataset, and 416 (2.8%) patients were under age 40 years, with 1176 (7.9%) between age 40 and 49 years in SEER dataset. Both datasets exhibited significantly proportional decreases of N3a and N3b LN+ with age increasing. Patients younger than age 40 years were more likely to show LN+ compared with the reference age 60 to 69 years. The youngest patients had the highest ORs of N1, N2, N3a, and N3b vs N0 LN+ within T4 stage of China dataset and T3 stage of SEER dataset, the values of ORs decreased with increasing age. Young age was a predictor of an increased number of LNs positive for each T stage.

Conclusion: In the two large datasets, young age at diagnosis is associated with an increased risk of LN+.

Keywords: gastric cancer, age, lymph node positivity

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