Early- versus late-onset gastroesophageal cancer: real-world outcomes from a 13-year central European cohort study

Gastroesophageal cancer presents variably across different age groups, with early-onset (EO) cases showing distinct pathological and clinical characteristics compared to late-onset (LO) disease. This study aims to delineate these differences and assess treatment outcomes in a Central European population. Data from patients diagnosed with gastroesophageal carcinoma and treated between 2010 and 2022, at a high-volume comprehensive cancer center representing approximately 5% of all national gastroesophageal cancer cases in the Czech Republic, were retrospectively analyzed. Patients were categorized into EO (< 50 years) and LO (≥ 50 years) groups. Clinicopathological characteristics were compared in the entire cohort, while treatment patterns and survival outcomes were evaluated in patients with adenocarcinoma. A total of 1,377 patients were included, with 161 (11.7%) classified as EO. EO patients are more frequently present with ECOG performance status 0 (42%), lower BMI, current smoking (44%), gastric cancer primaries (63%), and aggressive tumor characteristics such as poorly cohesive adenocarcinoma subtype (45%) and metastatic disease (55%). Hereditary cancer syndrome was confirmed in 4.3% of EO cases. Among adenocarcinoma patients, triplet chemotherapy was more frequently used in the EO group (29% vs. 11%, p < 0.001) in the first-line setting. However, no significant survival benefit was observed in inoperable or metastatic disease (median overall survival 9.1 vs. 9.6 months in EO and LO, respectively, p = 0.913). EO gastroesophageal cancer in the Central European population is associated with distinct clinicopathological characteristics, with no significant impact on survival. This study identifies distinct clinicopathological characteristics in early-onset gastroesophageal cancer in Central Europe, characterized by more aggressive attributes but without significant survival differences compared to late-onset cases.