Functional, nutritional, and inflammatory predictors of survival in early-onset gastric cancer

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Abstract
Aim: Early-onset gastric cancer (EOGC) represents a distinct subgroup with aggressive clinicopathological features; however, prognostic data in younger patients remain limited. This study aimed to evaluate clinicopathological characteristics and identify prognostic factors associated with survival in patients aged ≤ 50 years with gastric cancer.Materials and Methods: A total of 60 patients aged ≤ 50 years diagnosed with gastric cancer between 2014 and 2024 were included in this retrospective single-center study. Survival outcomes were analyzed using the Kaplan–Meier method, and prognostic factors were evaluated with Cox proportional hazards regression analysis.Results: The median age was 40.9 years, and 51.7% of patients were female. Diffuse or signet-ring cell histology and advanced-stage disease were frequently observed. Median progression-free survival (PFS) and overall survival (OS) were 19.3 and 26.0 months, respectively. Signet-ring cell histology, low Prognostic Nutritional Index (PNI), and elevated platelet-to-lymphocyte ratio (PLR) were associated with shorter PFS. In univariate analysis, poor Eastern Cooperative Oncology Group (ECOG) performance status (PS), low PNI, advanced stage, and total gastrectomy were associated with inferior survival. In multivariate analysis, ECOG PS 3 and elevated PLR independently predicted mortality.Conclusions: EOGC commonly presents with advanced disease and unfavorable outcomes. Both tumor-related factors and host-related parameters—including functional status, nutritional condition, and systemic inflammatory markers—play an important role in determining prognosis and may improve risk stratification in younger patients.

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