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Abstract：
BACKGROUND: The impact of racial and regional disparity on younger patients with gastric cancer (GC) remains unclear.
OBJECTIVE: To investigate the clinicopathological characteristics, prognostic nomogram, and biological analysis of younger GC patients in China and the United States.
METHODS: From 2000 to 2018, GC patients aged less than 40 years were enrolled from the China National Cancer Center and the Surveillance Epidemiology and End Results database. Biological analysis was performed based on the Gene Expression Omnibus database. Survival analysis was conducted via Kaplan-Meier estimates and Cox proportional hazards models.
RESULTS: A total of 6098 younger GC patients were selected from 2000 to 2018, of which 1159 were enrolled in the China National Cancer Center, and 4939 were collected from the Surveillance Epidemiology and End Results database. Compared with the United States group, younger patients in China revealed better survival outcomes (P < 0.01). For race/ethnicity, younger Chinese cases also enjoyed a better prognosis than that in White and Black datasets (P < 0.01). After stratification by pathological Tumor-Node-Metastasis (pTNM) stage, a survival advantage was observed in China with pathological stage I, III, and IV (all P < 0.01), whereas younger GC patients with stage II showed no difference (P = 0.16). In multivariate analysis, predictors in China involved period of diagnosis, linitis plastica, and pTNM stage, while race, diagnostic period, sex, location, differentiation, linitis plastica, signet ring cell, pTNM stage, surgery, and chemotherapy were confirmed in the United States group. Prognostic nomograms for younger patients were established, with the area under the curve of 0.786 in the China group and of 0.842 in the United States group. Moreover, three gene expression profiles (GSE27342, GSE51105, and GSE38749) were enrolled in further biological analysis, and distinctive molecular characteristics were identified in younger GC patients among different regions.
CONCLUSIONS: Except for younger cases with pTNM stage II, a survival advantage was observed in the China group with pathological stage I, III, and IV compared to the United States group, which might be partly due to differences in surgical approaches and the improvement of the cancer screening in China. The nomogram model provided an insightful and applicable tool to evaluate the prognosis of younger patients in China and the United States. Furthermore, biological analysis of younger patients was performed among different regions, which might partly explain the histopathological behavior and survival disparity in the subpopulations.
OBJECTIVE: To investigate the clinicopathological characteristics, prognostic nomogram, and biological analysis of younger GC patients in China and the United States.
METHODS: From 2000 to 2018, GC patients aged less than 40 years were enrolled from the China National Cancer Center and the Surveillance Epidemiology and End Results database. Biological analysis was performed based on the Gene Expression Omnibus database. Survival analysis was conducted via Kaplan-Meier estimates and Cox proportional hazards models.
RESULTS: A total of 6098 younger GC patients were selected from 2000 to 2018, of which 1159 were enrolled in the China National Cancer Center, and 4939 were collected from the Surveillance Epidemiology and End Results database. Compared with the United States group, younger patients in China revealed better survival outcomes (P < 0.01). For race/ethnicity, younger Chinese cases also enjoyed a better prognosis than that in White and Black datasets (P < 0.01). After stratification by pathological Tumor-Node-Metastasis (pTNM) stage, a survival advantage was observed in China with pathological stage I, III, and IV (all P < 0.01), whereas younger GC patients with stage II showed no difference (P = 0.16). In multivariate analysis, predictors in China involved period of diagnosis, linitis plastica, and pTNM stage, while race, diagnostic period, sex, location, differentiation, linitis plastica, signet ring cell, pTNM stage, surgery, and chemotherapy were confirmed in the United States group. Prognostic nomograms for younger patients were established, with the area under the curve of 0.786 in the China group and of 0.842 in the United States group. Moreover, three gene expression profiles (GSE27342, GSE51105, and GSE38749) were enrolled in further biological analysis, and distinctive molecular characteristics were identified in younger GC patients among different regions.
CONCLUSIONS: Except for younger cases with pTNM stage II, a survival advantage was observed in the China group with pathological stage I, III, and IV compared to the United States group, which might be partly due to differences in surgical approaches and the improvement of the cancer screening in China. The nomogram model provided an insightful and applicable tool to evaluate the prognosis of younger patients in China and the United States. Furthermore, biological analysis of younger patients was performed among different regions, which might partly explain the histopathological behavior and survival disparity in the subpopulations.
摘要：
背景：种族和地区差异对年轻胃癌（GC）患者的影响尚不清楚。
目的：探讨临床病理特征，预后列线图，中国和美国年轻GC患者的生物学分析。
方法：从2000年至2018年，年龄小于40岁的GC患者来自中国国家癌症中心和监测流行病学和最终结果数据库。基于基因表达综合数据库进行生物学分析。通过Kaplan-Meier估计和Cox比例风险模型进行生存分析。
结果：从2000年至2018年共选择6098名年轻GC患者，其中1159名在中国国家癌症中心登记。和4939来自监测流行病学和最终结果数据库。与美国集团相比，中国年轻患者的生存结果较好（P<0.01）。对于种族/民族，年轻的中国病例的预后也优于白人和黑人数据集（P<0.01）。按病理肿瘤淋巴结转移（pTNM）分期分层后，在病理阶段I的中国观察到生存优势，III,和IV（均P<0.01），而II期的年轻GC患者没有差异（P=0.16）。在多变量分析中，中国的预测因子涉及诊断期，linitisplastica,和pTNM阶段，而种族,诊断期,性别,location,分化,linitisplastica,印戒细胞,pTNM阶段，手术,和化疗在美国组中得到证实。建立了年轻患者的预后列线图，中国组的曲线下面积为0.786，美国组为0.842。此外，三个基因表达谱（GSE27342，GSE51105和GSE38749）被纳入进一步的生物学分析，在不同地区的年轻GC患者中发现了独特的分子特征。
结论：除了年轻的pTNMII期病例，在病理阶段I的中国组中观察到生存优势，III,与美国集团相比，这可能部分是由于手术方式的差异和中国癌症筛查的改进。列线图模型为评估中国和美国年轻患者的预后提供了一个有见地和适用的工具。此外，对不同地区的年轻患者进行生物学分析，这可能部分解释了亚群的组织病理学行为和生存差异。
目的：探讨临床病理特征，
方法：从2000年至2018年，年龄小于40岁的GC患者来自中国国家癌症中心和监测流行病学和最终结果数据库。
结果：从2000年至2018年共选择6098名年轻GC患者，其中1159名在中国国家癌症中心登记。
结论：除了年轻的pTNMII期病例，
