Jeong SA, Lee JB, Kim JH. Clinicopathological characteristics and survival outcomes of early-onset vs mid-aged gastric cancer using an evidence-based age cutoff. World J Gastroenterol 2026; 32(44): 120795 [DOI: 10.3748/wjg.120795]
Corresponding Author of This Article
Seong-A Jeong, MD, Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. sajeong90@gmail.com
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Gastroenterology & Hepatology
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research-article
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Jeong SA, Lee JB, Kim JH. Clinicopathological characteristics and survival outcomes of early-onset vs mid-aged gastric cancer using an evidence-based age cutoff. World J Gastroenterol 2026; 32(44): 120795 [DOI: 10.3748/wjg.120795]
World J Gastroenterol. Nov 28, 2026; 32(44): 120795 Published online Nov 28, 2026. doi: 10.3748/wjg.120795
Clinicopathological characteristics and survival outcomes of early-onset vs mid-aged gastric cancer using an evidence-based age cutoff
Seong-A Jeong, Jung Bok Lee, Ji Hoon Kim
Seong-A Jeong, Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
Seong-A Jeong, Ji Hoon Kim, Department of Surgery, Gangneung Asan Hospital, Gangneung 25440, South Korea
Jung Bok Lee, Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Songpa-gu, South Korea
Author contributions: Jeong SA and Kim JH designed the research study, collected the data, and created the images; Jeong SA and Lee JB were involved in the formal analysis and interpretation of the results; Jeong SA wrote the original manuscript; Jeong SA, Kim JH, and Lee JB reviewed and edited the manuscript. All authors have read and approved the final manuscript.
AI contribution statement: The manuscript underwent formal English editing by a professional editing company (Editage). As a non-native English-speaking author, I used an AI tool to receive assistance with ensuring that some sentences were grammatically correct in English during the drafting process. All content and ideas, however, were generated solely by the author. After the main manuscript was fully drafted by the authors, the AI tool was used only to assist in drafting the Abstract based on the complete text.
Institutional review board statement: The present study, which analyzed both retrospective and prospective registry data, received separate Institutional Review Board approval (No. GNAH 2025-05-018).
Informed consent statement: All eligible patients provided written informed consent and were informed of their right to withdraw consent at any time.
Conflict-of-interest statement: Jeong SA has no conflict of interest relevant to this article. Lee JB has no conflict of interest relevant to this article. Kim JB has no conflict of interest relevant to this article.
Data sharing statement: All data generated or analyzed during this study are included in this published article. The raw registry data can be provided to qualified researchers after deliberation and approval by the Data Review Committee of the Medical Research Institute at Gangneung Asan Hospital, confirming that there are no ethical concerns.
Corresponding author: Seong-A Jeong, MD, Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. sajeong90@gmail.com
Received: March 9, 2026 Revised: March 26, 2026 Accepted: April 10, 2026 Published online: November 28, 2026 Processing time: 206 Days and 12.6 Hours
Abstract
BACKGROUND
The prognosis of early-onset gastric cancer (EOGC) remains debated. Comparing EOGC directly with older patients can bias survival outcomes due to differences in life expectancy and age-related comorbidities. To isolate the specific oncological behavior of EOGC, comparisons with mid-aged patients are necessary. We hypothesized that after adjusting for these factors, EOGC does not portend worse survival than mid-aged gastric cancer (M-GC), despite its aggressive histological traits, when managed with standardized radical surgery.
AIM
To compare clinicopathological characteristics and survival outcomes between EOGC and M-GC using an evidence-based age cutoff and inverse probability of treatment weighting (IPTW).
METHODS
We analyzed a single-center surgical registry of patients who underwent gastrectomy for gastric adenocarcinoma between January 2013 and March 2020. Using an evidence-based cut-off of 50 years, patients were categorized into EOGC (≤ 50 years, n = 105) and M-GC (51-75 years, n = 532) groups. IPTW was applied to adjust for baseline imbalances. Recurrence-free survival (RFS) and overall survival (OS) were the primary outcomes compared.
RESULTS
A total of 637 patients were included; 105 (16.5%) were classified as having EOGC. Diffuse-type histology was more frequent in EOGC; patients with EOGC had fewer comorbidities and a lower Charlson comorbidity index. In the entire cohort, EOGC demonstrated superior 5-year RFS compared with M-GC [80.74% vs 72.18%; hazard ratio (HR), 0.57; 95% confidence interval (CI): 0.360-0.890; P = 0.014], whereas 5-year OS was comparable between the groups (78.38% vs 75.33%; HR, 0.69; 95%CI: 0.461-1.033; P = 0.072). After IPTW adjustment, 5-year RFS and OS were significantly higher in the EOGC group. Stage-stratified analyses showed consistently favorable RFS in EOGC, with a significant difference observed in stage III disease.
CONCLUSION
EOGC shows favorable survival despite aggressive histology. High treatment tolerance justifies optimistic counseling and prioritization of standard radical surgery and multimodal therapy to optimize clinical outcomes for these patients.
Core Tip: This study compares early-onset gastric cancer (EOGC) and mid-aged gastric cancer (M-GC) using an evidence-based age cutoff of 50 years and inverse probability of treatment weighting to minimize age-related confounders. Despite a higher prevalence of aggressive diffuse-type histology, EOGC patients demonstrated superior recurrence-free and overall survival compared to M-GC patients. These findings suggest that the perceived biological aggressiveness of EOGC does not necessarily translate into poorer outcomes when standardized radical surgery and adjuvant therapies are effectively delivered. This underscores the importance of optimized management for the growing young adult patient population.
