Analysis of demographic characteristics in 3242 young age gastric cancer patients in Korea

AIM:To evaluate the epidemiologic features of young age gastric cancer(GC). METHODS:Retrospectively,a total of 3242 patients with GC between 18 and 45 years of age and 3000 sex-and age-matched controls were reviewed.All subjects were stratified into 3 groups based on age (A,18-30 years;B,31-40 years;C,41-45 years). Epidemiologic characteristics and risk factors were investigated with reference to their age and gender. RESULTS:Compared to controls,more frequent intake of high risk diet(P=0.00075),history of heavy smoking(P=0.00087),intake of heavy alcohol(P= 0.00091),lower social economic status(P=0.00083), body mass index>30(P=0.00097),urban residence(P=0.00065),and more frequent exposure to harmful occupational environments(P=0.00072)were observed in all age groups and both genders in young age GC.These relationships were weaker in females compared to males of the same age,and were stronger as the age of patients increased.However,in group C of young age GC patients,environmental factors played important roles in females and males with a similar body weight.In females,older age at first delivery(> 35 years),lack of lactation history,nulliparity,and poor nutritional status during pregnancy were significantly associated with an increased risk of GC(P=0.00034). In this study,252 patients(7.8%)had a family history of GC with high odds ratio(OR)(3.22-4.21).In particular, family history was more closely associated with GC in males(OR,4.21 in male vs 3.46 in female)and more advanced cases(P=0.00051). CONCLUSION:Hormonal associated factors were more commonly associated with females whereas environmental factors were more commonly associated with males in young age GC patients.

Colorectal cancer in young adults: A difficult challenge

Sporadic colorectal cancer(CRC) is traditionally diagnosed after the sixth decade of life,and current recommendations for surveillance include only patients older than 50 years of age. However,an increasing incidence of CRC in patients less than 40 years of age has been reported. This occurrence has been attributed to different molecular features and low suspicion of CRC in young symptomatic individuals. When confronting young-onset CRC with older patients,issues such as biological aggressiveness,stage at diagnosis and clinical outcomes seem to differ in many aspects. In the future,the identification of the molecular profile underlying the early development of sporadic CRC will help to plan tailored screening recommendations and improve management. Besides that,differential diagnosis with CRC linked with hereditary syndromes is necessary to provide adequate patient treatment and family screening. Until we find the answers to some of these doubts,doctors should raise suspicion when evaluating an young adult and be aware of this risk and consequences of a late diagnosis.

High-grade serous carcinoma of the fallopian tube in a young woman with chromosomal 4q abnormality:A case report

BACKGROUND Few studies have reported an association between an increased risk of acquiring cancers and survival in patients with 4q deletion syndrome.This study presents a rare association between chromosome 4q abnormalities and fallopian tube highgrade serous carcinoma(HGSC)in a young woman.CASE SUMMARY A 35-year-old woman presented with acute dull abdominal pain and a known chromosomal abnormality involving 4q13.3 duplication and 4q23q24 deletion.Upon arrival at the emergency room,her abdomen appeared ovoid and distended with palpable shifting dullness.Ascites were identified through abdominal ultrasound,and computed tomography revealed an omentum cake and an enlarged bilateral adnexa.Blood tests showed elevated CA-125 levels.Paracentesis was conducted,and immunohistochemistry indicated that the cancer cells favored an ovarian origin,making us suspect ovarian cancer.The patient underwent debulking surgery,which led to a diagnosis of stage IIIC HGSC of the fallopian tube.Subsequently,the patient received adjuvant chemotherapy with carboplatin and paclitaxel,resulting in stable current condition.CONCLUSION This study demonstrates a rare correlation between a chromosome 4q abnormality and HGSC.UBE2D3 may affect crucial cancer-related pathways,including P53,BRCA,cyclin D,and tyrosine kinase receptors,thereby possibly contributing to cancer development.In addition,ADH1 and DDIT4 may be potential influencers of both carcinogenic and therapeutic responses.

Clinical characteristics of patients in their forties who underwent surgical resection for colorectal cancer in Korea

BACKGROUND The proportion of young patients with colorectal cancer(CRC),especially in their 40s,is increasing worldwide.AIM To confirm the clinical characteristics of such patients,we planned a study comparing them to patients in their 30s and 50s.METHODS Patients undergoing primary resection for CRC,patients in their 30s,40s and 50s were included in the study.Patient and tumor characteristics,and perioperative and oncologic outcomes were compared.RESULTS Most clinical characteristics of 451(10.5%)patients in their 40s were more similar to those of patients in their 30s than those in their 50s.On pathology data,there were more metastatic lesions(30s vs 40s vs 50s;17.5%vs 21.1%vs 14.9%,P=0.012)in patients in their 40s.There was a trend toward less frequent K-ras mutations among patients in their 40s(48.5%vs 33.3%vs 44.5%,P=0.064).The proportion of patients receiving postoperative chemotherapy was also significantly greater among patients in their 40s(58.3%vs 63.9%vs 56.3%,P=0.032).Five-year overall survival(OS)and disease-free survival(DFS)did not differ between the three groups(5-year OS,92.2%vs 89.8%vs 92.2%,P=0.804;5-year total DFS,98.6%vs 95.7%vs 96.1%,P=0.754;5-year local DFS,98.6%vs 94.3%vs 94.9%,P=0.579;5-year systemic DFS,86.4%vs 87.9%vs 86.4%,P=0.908).CONCLUSION Patients with CRC in their 40s showed significantly more numerous metastatic lesions.The oncologic outcome of stage 1-3 patients in their 40s was not inferior compared to that of those in their 30s and 50s.

Identification of Germline Mutations in East‑Asian Young Never‑Smokers with Lung Adenocarcinoma by Whole‑Exome Sequencing

Recently,an increasing number of young never-smokers are diagnosed with lung cancer.The aim of this study is to investigate the genetic predisposition of lung cancer in these patients and discover candidate pathogenic variants for lung adenocarcinoma in young never-smokers.Peripheral blood was collected from 123 never-smoking east-Asian patients diagnosed with lung adenocarcinoma before the age of 40.Whole-exome sequencing(WES)was conducted on genomic DNA extracted from peripheral blood cells.As a result,3,481 single nucleotide variants were identified.By bioinformatical tools and the published gene list associated with genetic predisposition of cancer,pathogenic variants were detected in ten germline genes:ATR,FANCD2,FANCE,GATA2,HFE,MSH2,PDGFRA,PMS2,SDHB,and WAS.Patients with pathogenic variants were more likely to occur in females(9/10,90.0%)and have stage IV lung adenocarcinoma(4/10,40%).Furthermore,germline muta-tions in 17 genes(ASB18,B3GALT5,CLEC4F,COL6A6,CYP4B1,C6orf132,EXO1,GATA4,HCK,KCP,NPHP4,PIGX,PPIL2,PPP1R3G,RRBP1,SALL4,and TTC28),which occurred in at least two patients,displayed potentially pathogenic effects.Gene ontology analysis further showed that these genes with germline mutations were mainly located in nucleo-plasm and associated with DNA repair-related biological processes.The study provides spectrum of pathogenic variants and functional explanation for genetic predisposition of lung adenocarcinoma in young never-smokers,which sheds a light on prevention and early diagnosis of lung cancer.

Risk factors related to acute renal failure after cardiac surgery for congenital heart disease in low body weight infants

Background Acute renal failure （ARF） is a common complication and a very important cause of postoperative death in children with congenital heart disease. Large cohort investigation of the morbidity and related risk factors for ARF in very young and low-body-weight children in China is still absent. Methods Data of 518 infants after cardiac surgery were analyzed retrospectively. The correlation between multivariate risk factors and ARF after cardiac surgery was analyzed by logistic regression. Results The incidence of postoperative ARF within 30 days was 6.9% （n = 36）. High RACHS-1 Score, long duration of CPB, rethoracotomy exploration and postoperative low cardiac output were independent risk factors of ARF. There were statistical significances in intensive care unit staying [（21.73 ± 7.28） days vs （7.41 ± 3.76） days], P 0. 001] and mortality （27.8% vs 7.5%, P 0. 001） between the patients with or without ARF. Conclusions Acute renal failure is a key negative factor for the survivors after cardiac surgery for congenital heart disease in very young patients with low body weight. High RACHS-1 Score, long duration of CPB, rethoracotomy exploration and postoperative low cardiac output are independent risk factors for development of ARF.