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Ajay PS, Rajamanickam RK, Rhee K, NeMoyer R, Goyal S, Switchenko JM, Lin Y, Jabbour SK, Carpizo DR, Kennedy TJ, Shah MM. Identifying the optimal treatment strategy in patients with resectable non-cardia gastric cancer. Surg Endosc 2024; 38:136-147. [PMID: 37935921 PMCID: PMC10843560 DOI: 10.1007/s00464-023-10515-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/08/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Multimodal treatment strategy including perioperative chemotherapy (PEC), postoperative chemoradiation therapy (POCR), and postoperative chemotherapy (POC) has been accepted as the standard of care in gastric cancer (GC). The ideal sequence and type of therapy remain undetermined. METHOD The National Cancer Database was examined from 2006 to 2016 to identify patients with resectable non-cardia gastric cancer. Patient outcomes were compared based on the receipt of PEC, POCR, and POC. This comparison was repeated in a sub-group of patients who received optimal treatment. Optimal treatment was defined as initial chemotherapy within 45 days of diagnosis, resection within 45 days of diagnosis, negative margins, adjuvant chemotherapy within 90 days of resection and standard radiation dose (45 Gy). Kaplan-Meier test, log-rank test, and multivariable analysis (MVA) were performed. RESULTS We identified 9589 patients. Median survival was greater in the PEC group followed by POCR and POC (60.6, 42.3, and 31.2 months, respectively). On MVA, factors associated with worse overall survival included age above median (≥ 63 years), Charlson-Deyo score of ≥ 1, non-academic/research program, poorly differentiated/undifferentiated grade, positive margins, and positive lymph nodes. Both PEC and POCR were associated with improved survival when compared to POC (HR 0.78 and 0.79; p < 0.001). When compared with PEC, no significant difference was noted with POCR (HR 1.01; p = 0.987). These results were maintained in optimally treated cohort (n = 3418). CONCLUSION In patients with resectable non-cardia gastric cancer, both perioperative chemotherapy and postoperative chemoradiation therapy were associated with improved survival when compared to postoperative chemotherapy. No difference was noted between perioperative chemotherapy and postoperative chemoradiation therapy. These results were maintained in the optimally treated cohort.
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Affiliation(s)
- Pranay S Ajay
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Kevin Rhee
- Division of General Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel NeMoyer
- Division of Thoracic and Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Subir Goyal
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jeffery M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yong Lin
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, New Brunswick, NJ, USA
| | - Salma K Jabbour
- Division of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Darren R Carpizo
- Division of Surgical Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, NY, USA
| | - Timothy J Kennedy
- Division of Surgical Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Mihir M Shah
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
- Division of Surgical Oncology, Emory University School of Medicine/Winship Cancer Institute, 5665 Peachtree Dunwoody Road, Atlanta, GA, 30342, USA.
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Paragomi P, Dabo B, Pelucchi C, Bonzi R, Bako AT, Sanusi NM, Nguyen QH, Zhang ZF, Palli D, Ferraroni M, Vu KT, Yu GP, Turati F, Zaridze D, Maximovitch D, Hu J, Mu L, Boccia S, Pastorino R, Tsugane S, Hidaka A, Kurtz RC, Lagiou A, Lagiou P, Camargo MC, Curado MP, Lunet N, Vioque J, Boffetta P, Negri E, La Vecchia C, Luu HN. The Association between Peptic Ulcer Disease and Gastric Cancer: Results from the Stomach Cancer Pooling (StoP) Project Consortium. Cancers (Basel) 2022; 14:4905. [PMID: 36230828 PMCID: PMC9563899 DOI: 10.3390/cancers14194905] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Gastric cancer (GC) is the fifth most common type of cancer and the fourth most common cause of cancer-related mortality. Although the risk of GC and peptic ulcer disease (PUD) is known to be increased by H. pylori infection, evidence regarding the direct relationship between PUD and GC across ethnicities is inconclusive. Therefore, we investigated the association between PUD and GC in the Stomach cancer Pooling (StoP) consortium. METHODS History of peptic ulcer disease was collected using a structured questionnaire in 11 studies in the StoP consortium, including 4106 GC cases and 6922 controls. The two-stage individual-participant data meta-analysis approach was adopted to generate a priori. Unconditional logistic regression and Firth's penalized maximum likelihood estimator were used to calculate study-specific odds ratios (ORs) and 95% confidence intervals (CIs) for the association between gastric ulcer (GU)/duodenal ulcer (DU) and risk of GC. RESULTS History of GU and DU was thoroughly reported and used in association analysis, respectively, by 487 cases (12.5%) and 276 controls (4.1%), and 253 cases (7.8%) and 318 controls (6.0%). We found that GU was associated with an increased risk of GC (OR = 3.04, 95% CI: 2.07-4.49). No association between DU and GC risk was observed (OR = 1.03, 95% CI: 0.77-1.39). CONCLUSIONS In the pooled analysis of 11 case-control studies in a large consortium (i.e., the Stomach cancer Pooling (StoP) consortium), we found a positive association between GU and risk of GC and no association between DU and GC risk.
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Affiliation(s)
- Pedram Paragomi
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA
| | - Bashir Dabo
- Epidemiology and Biostatistics Concentration, College of Public Health, University of South Florida, Tampa, FL 33620, USA
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero University, Kano 700006, Nigeria
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
| | - Rossella Bonzi
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
| | - Abdulaziz T. Bako
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, TX 77030, USA
| | - Nabila Muhammad Sanusi
- Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano 700006, Nigeria
| | - Quan H. Nguyen
- Institute for Molecular Bioscience, School of Biomedical Sciences, University of Queensland, Brisbane, QLD 4072, Australia
| | - Zuo-Feng Zhang
- Department of Epidemiology, UCLA Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, USA
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, ISPRO, 50139 Florence, Italy
| | - Monica Ferraroni
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
| | - Khanh Truong Vu
- Department of Gastroenterology and Pancreato-Hepatobiliary, Tam Anh General Hospital, Hanoi 100000, Vietnam
| | - Guo-Pei Yu
- Medical Informatics Center, Peking University, Beijing 100871, China
| | - Federica Turati
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
| | - David Zaridze
- Department of Clinical Epidemiology, N.N. Blokhin National Medical Research Center for Oncology, 115478 Moscow, Russia
| | - Dmitry Maximovitch
- Department of Clinical Epidemiology, N.N. Blokhin National Medical Research Center for Oncology, 115478 Moscow, Russia
| | - Jinfu Hu
- Department of Epidemiology, Harbin Medical University, Harbin 150081, China
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Roberta Pastorino
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo 104-0045, Japan
- National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan
| | - Akihisa Hidaka
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo 104-0045, Japan
| | - Robert C. Kurtz
- Department of Medicine, Memorial Sloan Kettering Cancer Centre, New York, NY 10065, USA
| | - Areti Lagiou
- Department of Public and Community Health, School of Public Health, University of West Attica, 115 21 Athens, Greece
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115-5810, USA
| | - M. Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20892, USA
| | - Maria Paula Curado
- Centro Internacional de Pesquisa, A. C. Camargo Cancer Center, 01509-010 São Paulo, Brazil
| | - Nuno Lunet
- EPIUnit, Instituto de Saúde Pública da Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Jesus Vioque
- Department, Instituto de Investigación Sanitaria y Biomédica de Alicante, Universidad Miguel Hernandez (ISABIAL-UMH), 46020 Alicante, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brooke University, Stony Brook, NY 11794, USA
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
| | - Hung N. Luu
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Zhao L, Niu P, Zhao D, Chen Y. Regional and racial disparity in proximal gastric cancer survival outcomes 1996-2016: Results from SEER and China National Cancer Center database. Cancer Med 2021; 10:4923-4938. [PMID: 34105890 PMCID: PMC8290239 DOI: 10.1002/cam4.4033] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Given the growing incidence and aggressive biological behavior of proximal gastric cancer (PGC) as reported, it is important to understand which regional or racial populations are at poor prognosis so that interventions can be treated appropriately. We sought to explore regional treatment differences as well as racial genes influence survival outcomes in China and the US patients with PGC. METHODS PGC patients defined as tumors with the epicenter located in cardia (C16.0) or fundus (C16.1) from 1996 to 2016 were identified from the Surveillance Epidemiology and End Results (SEER) in the United States as well as data from a high-volume National Cancer Center Database in China. Overall survival (OS) curves were plotted for different regional or racial groups, respectively, using the Kaplan-Meier method and compared statistically using the log-rank test. Differentially expressed genes (DEGs) analysis was performed using TCGA database. RESULTS Finally, the cohort consistent of 40973 PGC patients who enrolled in SEER database (n = 36305) or China National Cancer Center (n = 4668), and divided into 4 racial groups: Chinese (n = 5179), Black (n = 2429), White (n = 31185), and Others (n = 2096). After controlling for confounding variables, racial factors were independently associated with poor survival included Black ethnicity (HR = 1.376, 95% CI: 1.066-1.7760, p = 0.014) and White ethnicity (HR = 1.262, 95% CI: 1.005-1.583, p = 0.045) when compared to Chinese ethnicity in total PGC patients. Even in the same region for only US group, Chinese PGC patients also showed better prognosis. CONCLUSIONS In conclusion, we demonstrated the different survival outcomes of PGC patients in different regions or races from two high-volume database SEER and China National Cancer Center database. These survival differences are likely influenced by a number of factors (e.g., access to screening, quality of gastrectomy, neo/adjuvant therapy, and biological genes itself). More importantly, a better understanding of these disparities could lead to interventions that may help to abolish these disparities.
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Affiliation(s)
- Lulu Zhao
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Penghui Niu
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongbing Zhao
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingtai Chen
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lee SY. Helicobacter pylori-negative Gastric Cancer. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2021. [DOI: 10.7704/kjhugr.2020.0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
<i>Helicobacter pylori (H. pylori)</i>-negative gastric cancer is diagnosed when gastric malignancies are found in patients in <i>H. pylori</i>-naïve stomachs. There are four types of noncardiac <i>H. pylori</i>-negative gastric cancers. The signet ring cell-type poorly cohesive carcinoma is most common, followed by the chief cell-predominant type gastric adenocarcinoma of the fundic gland. Extremely well-differentiated adenocarcinoma of the corpus and well-differentiated pyloric gland cancers are rare outside Japan because of country-specific differences in diagnostic criteria. In endemic areas of <i>H. pylori</i> infection, strict criteria are required for diagnosing an <i>H. pylori</i>-naïve stomach. Both invasive and noninvasive <i>H. pylori</i> tests should show negative results in a subject without a history of <i>H. pylori</i> infection. Furthermore, the serum pepsinogen (PG) assay and endoscopic findings of the background gastric mucosa are required to discriminate subjects with past infections owing to spontaneous regression or unintended eradication of <i>H. pylori</i>. There should be no gastric corpus atrophy (PG I ≤70 ng/mL and PG I/II ≤3.0). Gastroscopy should reveal a regular arrangement of collecting venules without gastric xanthoma, metaplastic gastritis, or advanced atrophy over the angle. On biopsy, there should be no gastric atrophy, intestinal metaplasia, neutrophils, or <i>H. pylori</i> infiltration, and only a mild degree of mononuclear cell infiltration is permitted. The types and characteristics of noncardiac <i>H. pylori</i>-negative gastric cancers are summarized in this review, along with current diagnostic challenges found in Korea.
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Yoshikawa GT, Simon N, Nakasone RK, Acoba JD. Disaggregating Data on Pacific Islander Gastric Cancer Patients Reveals Survival Disparity. J Gastrointest Cancer 2021; 53:144-150. [PMID: 33392961 DOI: 10.1007/s12029-020-00579-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The incidence and prognosis of Pacific Islanders with gastric cancer is not well documented as previous studies have often aggregated this population with Asians. The purpose of our study was to describe patient and tumor characteristics, as well as prognostic factors of Pacific Islanders with gastric cancer. METHODS Patients diagnosed with gastroesophageal junction or gastric adenocarcinoma between 2000 and 2014 were identified in the tumor registry of the largest hospital in Hawaii. Overall survival of Asians, Whites, and Pacific Islanders were calculated using the Kaplan-Meier method and log-rank test. Cox proportional hazards regression models were constructed to assess predictors of survival adjusting for clinical and pathological factors. RESULTS A total of 615 patients were included in the final analysis. Pacific Islanders were found to present at a younger age, were more often uninsured or had Medicaid insurance, and were diagnosed with a higher stage of cancer compared to their Asian and White counterparts. Pacific Islanders were less likely to undergo surgery even after adjusting for stage. Race was a prognostic factor and survival was lowest among Pacific Islanders, but only if the model was unadjusted for treatment. CONCLUSIONS We present an analysis of the largest cohort of Pacific Islander gastric cancer patients. Pacific Islanders have different sociodemographic characteristics and inferior survival compared to Asian patients and should be independently studied.
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Affiliation(s)
- Gene T Yoshikawa
- University of Hawai'i Internal Medicine Residency Program, Honolulu, HI, USA
| | - Nicholas Simon
- John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, USA
| | - Ryon K Nakasone
- Internal Medicine Department, University of Hawai'i, Honolulu, HI, USA
| | - Jared D Acoba
- Internal Medicine Department, University of Hawai'i, Honolulu, HI, USA. .,University of Hawai'i Cancer Center, Honolulu, HI, USA. .,Queen's Medical Center, Honolulu, HI, USA.
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Rates of lymph node metastasis and survival in T1a gastric adenocarcinoma in Western populations. Gastrointest Endosc 2016; 83:1184-1192.e1. [PMID: 26546980 PMCID: PMC4862925 DOI: 10.1016/j.gie.2015.10.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 10/28/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS EMR and endoscopic submucosal dissection (ESD) are widely accepted in Asia for treatment of early gastric cancer (EGC). Few studies have examined lymph node (LN) metastasis of EGC in Western populations. We sought to examine EGC and LN metastasis in a heterogeneous Western population. METHODS Patients with surgically resected, histologically confirmed American Joint Committee on Cancer T1a gastric adenocarcinoma were identified in the Surveillance, Epidemiology, and End Results (SEER) database from 2002 to 2012. Patients were excluded if they had stage IV disease, had multiple primary cancers, or received neoadjuvant therapy. Rates of LN metastasis were calculated, and survival analyses were performed. RESULTS Of 923 patients in the cohort, 72 (7.8%) had at least 1 positive LN on final pathology. When stratified by race, Asian/Pacific Islanders (APIs) demonstrated the lowest rate of LN metastases (n = 17/327, 5.2%), followed by Hispanics (n = 12/171, 7.0%), whites (n = 27/278, 9.7%), and blacks (n = 16/147, 10.9%). The highest rates of stage IA disease were observed in API (93.9%) and Hispanic (92.4%) patients, followed by white (89.9%) and black (87.1%) patients (P = .04). Survival analysis of T1a gastric cancer patients by race/ethnicity showed that 5-year overall survival was highest for API patients (API, 88%; Hispanic, 81%; black, 79%; and white, 77%; P < .01). CONCLUSIONS The rate of LN metastasis in T1a gastric cancers in the United States is higher than the rates reported in Asia. Survival outcomes in T1a gastric cancers varied significantly by race, suggesting that definitive endoscopic treatment may not be appropriate for all patients in the United States.
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Byfield SAD, Earle CC, Ayanian JZ, McCarthy EP. Treatment and outcomes of gastric cancer among United States-born and foreign-born Asians and Pacific Islanders. Cancer 2009; 115:4595-605. [PMID: 19626648 PMCID: PMC2953712 DOI: 10.1002/cncr.24487] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The authors investigated whether stage at diagnosis, cancer treatments, and survival of Asian and Pacific Islander (API) gastric cancer patients in the United States vary by birthplace. METHODS The authors studied 6454 API and 10,099 non-Hispanic white (NHW) patients diagnosed with gastric cancer from the Surveillance, Epidemiology, and End Results program between 1992 and 2005. In descriptive analyses, stage, receipt of adequate lymph node examination (ALNE), and surgery were compared among US-born APIs, foreign-born (FB) APIs, and NHWs. Multivariate polytomous logistic and proportional hazards regression models were used to assess differences in cancer stage and survival, respectively, adjusted for clinical and demographic factors. RESULTS As a group, APIs were more likely than NHWs to present with earlier-stage diagnoses and receive surgery and ALNE (P < .001). However, FB (adjusted odds ratios [aOR], 0.79; 95% confidence interval [CI], 0.73-0.86) but not US-born APIs (aOR, 1.05; 95% CI, 0.92-1.20) were significantly more likely to present at earlier stages than NHWs. Compared with NHW patients, FB and US-born APIs were more likely to receive surgery (adjusted risk ratio [aRR], 1.06; 95% CI, 1.03-1.09 and aRR, 1.09; 95% CI, 1.03-1.14, respectively) and ALNE (aRR, 1.29; 95% CI, 1.19-1.41 and aRR, 1.14; 95% CI, 1.00-1.32, respectively). In fully adjusted models, FB (adjusted relative hazard ratios [aHR], 0.86; 95% CI, 0.82-0.90) but not US-born APIs (aHR, 0.96; 95% CI, 0.89-1.04) had more favorable survival than NHWs. CONCLUSIONS The earlier-stage diagnosis, more complete surgical treatment, and improved survival of Asians and Pacific Islanders with gastric cancer may result from less aggressive tumors or more prompt recognition and thorough evaluation of early symptoms. Further study of these factors could improve outcomes for all patients with gastric cancer.
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Affiliation(s)
- Stacey A Dacosta Byfield
- Division of Pharmacy, Department of Drug Use Policy and Pharmacoeconomics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Different pathological features and prognosis in gastric cancer patients coming from high-risk and low-risk areas of Italy. Ann Surg 2009; 250:43-50. [PMID: 19561483 DOI: 10.1097/sla.0b013e3181ad6487] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To compare clinicopathological features and long-term outcome in gastric cancer patients coming from high-risk and low-risk areas of Italy. SUMMARY BACKGROUND DATA Better survival rates have been reported from countries with higher incidence of gastric cancer. METHODS Data regarding 829 patients coming from Tuscany (group A) and 143 patients coming from Southern Italy (group B) were analyzed. Mean follow-up time was 56 +/- 57 months; it was 85 +/- 63 months in surviving patients or not tumor-related deaths. Prognostic factors were investigated by multivariate analysis with Cox proportional hazard model after verifying the assumption of proportionality of the risk associated with covariates. RESULTS Lauren diffuse-mixed histotype, younger age, extended lymphadenectomy, and advanced stages were more common in group B. Gastric cancer-related 10-year survival probability was 48% in group A versus 29% in group B (log-rank test: P < 0.001). By multivariate analysis, geographic area was confirmed as a significant prognostic factor (hazard ratio for group B vs. group A: 1.52, 95% confidence interval: 1.12-2.06, P = 0.006). The influence of this factor on long-term survival was independent from other clinical, surgical, and pathologic factors, and was notable in neoplasms involving the serosa (10-year survival probability: 15% in group A vs. 3% in group B, log-rank test: P = 0.005). CONCLUSIONS Patients coming from low-risk area of Italy showed distinct pathologic features, more advanced stage, and worse prognosis when compared with patients coming from high-risk area. These findings may be indicative of different tumor biology, and may contribute to partly explain worldwide geographic variability in prognosis reported in different series.
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