Research Paper Volume 12, Issue 18 pp 18137—18150

The clinicopathological characteristics and genetic alterations between younger and older gastric cancer patients with curative surgery

Chew-Wun Wu1,2, , Ming-Huang Chen2,3, , Kuo-Hung Huang1,2, , Shih-Ching Chang2,4, , Wen-Liang Fang1,2, , Chien-Hsing Lin5, , Yee Chao2,3, , Su-Shun Lo2,6, , Anna Fen-Yau Li2,7, , Yi-Ming Shyr1,2, ,

  • 1 Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
  • 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan
  • 3 Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
  • 4 Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
  • 5 Genome Research Center, National Yang-Ming University, Taipei, Taiwan
  • 6 National Yang-Ming University Hospital, Yilan, Taiwan
  • 7 Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan

Received: March 28, 2020       Accepted: June 22, 2020       Published: August 18, 2020
How to Cite

Copyright: © 2020 Wu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Few reports have investigated different genetic alterations according to age in various cancers. In total, 1749 GC patients receiving curative surgery were enrolled. The clinicopathological features, and prognoses were compared between younger (<65 years) and older (≥65 years) patients. Genetic mutations were analyzed using mass spectrometric single nucleotide polymorphism genotyping technology, including 68 validated mutations within eight genes (TP53, ARID1A, BRAF, and the PI3K/AKT pathway) previously reported in relation to age. Younger patients were more likely to be female and have poor cell differentiation, diffuse-type tumors, less lymphovascular invasion, fewer liver metastases, and better 5-year overall survival (OS) (68.0% vs. 54.6%, P<0.001) and disease-free survival (DFS) (65.4% vs. 53.0%, P<0.001) rates than older patients. Regarding the genetic alterations, older patients had more microsatellite instability-high (MSI-H) tumors and more ARID1A mutations than younger patients. Younger patients had significantly better OS and DFS rates than older patients for each pathological Tumor, Node, Metastasis (TNM) stage. Older patients had a significantly higher non-cancer related death rate than younger patients (36.2% vs. 12.3%, P<0.001). Age was an independent prognostic factor in GC. In conclusion, age was associated with different clinicopathological features and genetic alterations in GC with curative surgery.


AJCC: American Joint Committee on Cancer; DFS: Disease-free survival; EBV: Epstein-Barr virus; GC: Gastric cancer; HP: Helicobacter pylori; MSI: Microsatellite instability; MSI-H: Microsatellite instability-high; MSI-L/S: Microsatellite instability-low/stable; OS: Overall survival; PCR: Polymerase chain reaction; TCGA: The Cancer Genome Atlas; UICC: Union for International Cancer Control.