Racial and ethnic disparities in gastric cancer outcomes: More important than surgical technique?

Merchant, Shaila J.; Li, Lily; Kim, Joseph

doi:10.3748/wjg.v20.i33.11546

Cited by 33 publications

(30 citation statements)

References 51 publications

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“…Koreans had a remarkably low proportion of cardia gastric cancer, contributing further to their overall advantage. Asian race has been shown to be an independent prognostic factor for gastric cancer survival in many studies [6][7][8][9][10][11][12][13][14][15][16][17]. Here, we bolster those findings, demonstrating with multivariate analyses that each of the six major Asian ethnic groups has a survival advantage compared to NHWs.…”

Section: Discussionsupporting

confidence: 72%

“…Previous research, while not conclusive, has linked the survival advantage of Asian Americans to tumors at a more distal anatomic site, diagnosis at earlier tumor stages, diagnosis at younger ages, and more aggressive treatment approaches [6][7][8][9][10][11][12][13][14][15][16][17][18]. However, Asian Americans are heterogeneous, not only genetically, but also with respect to lifestyle, culture, immigration, and settlement experiences [19].…”

Section: Introductionmentioning

confidence: 99%

“…Compared to non-Hispanic whites (NHWs), Asian Americans, as a whole, have higher gastric cancer incidence, but also have better survival outcomes [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Previous research, while not conclusive, has linked the survival advantage of Asian Americans to tumors at a more distal anatomic site, diagnosis at earlier tumor stages, diagnosis at younger ages, and more aggressive treatment approaches [6][7][8][9][10][11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Examining the gastric cancer survival gap between Asians and whites in the United States

et al. 2016

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Background Globally, Asian countries bear a disproportionate gastric cancer burden. Asian Americans, the fastest growing minority population in the US, have higher gastric cancer survival than non-Hispanic whites (NHWs) despite higher incidence. Benefitting from uniform cancer registry standards within the US, we examine for the first time the heterogeneity in the Asian American population, which may elucidate the causes of these disparities. Methods SEER gastric cancer data from 2000 to 2012 were used to calculate 5-year survival estimates for NHWs and the six largest Asian ethnicities. Multivariate analyses were performed to identify critical prognostic factors and survival disparities between Asian groups and NHWs. Results We analyzed 33,313 NHW and 8473 Asian gastric cancer cases. All Asian groups had significantly higher 5-year survival than NHWs, at 29.8%. Among Asians, Koreans and Vietnamese had the highest and lowest survival, at 45.4% and 35.7%, respectively. The Korean survival advantage was largely attributable to relatively high proportions of localized stage and low proportions of cardia tumors. After adjusting for major prognostic factors, the survival disadvantage of NHWs, while attenuated, remained significant in comparison to all Asian groups (HR: 1.33, 95% CI: 1.24-1.43; reference: Korean). The survival disparities within the Asian groups vanished with adjustment. Conclusions This study characterizes distinctive gastric cancer survival patterns among the six major Asian groups and NHWs in the US. The favorable survival for Koreans is largely attributable to specific clinical factors, particularly stage at diagnosis. The causes of the survival disadvantage for NHWs remain elusive.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Examining the gastric cancer survival gap between Asians and whites in the United States

et al. 2016

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“…For patients with gastric adenocarcinoma (GAC), these disparities are especially harmful as GAC represents the second leading cause of cancer‐related deaths worldwide . Surgical resection with regional lymphadenectomy remains the mainstay of curative treatment for GAC, and although historically disenfranchised groups are reported to receive adequate surgical therapy, multiple groups have demonstrated that black and Hispanic patients are less likely to receive adequate comprehensive oncologic treatment with multimodal therapy, and patients who suffer from socioeconomic marginalization have a shorter duration of survival even after a curative‐intent, margin‐negative resection . In studying these disparities, an oftentimes complex, multifactorial picture is painted with a single root cause rarely identified.…”

Section: Introductionmentioning

confidence: 99%

Identifying the barriers to gastric cancer care at safety‐net hospitals: A novel comparison of a safety‐net hospital to a neighboring quaternary referral academic center in the same healthcare system

Zaidi

Rappaport

Ethun

et al. 2018

Journal of Surgical Oncology

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Background:The three-delays model describes delays in seeking, reaching, and receiving care for vulnerable populations needing treatment. The dominant delay for patients with gastric adenocarcinoma (GAC) is unknown. We aimed to define patients with GAC who reached and received care at our regional safety-net hospital (Grady Memorial Hospital [GMH]) and our neighboring quaternary referral hospital (Emory University Hospital [EUH]). Methods: Clinicopathologic data from National Cancer Database (NCDB) participating academic centers were compared with GMH from 2004 to 2014. Outcomes of patients undergoing surgery at GMH were compared to those at EUH. Results: At presentation, compared to NCDB centers (n = 69 662), GMH patients (n = 154) were more often black (85.1 vs 17.2%; P < 0.001), uninsured (30.5 vs 4.7%; P < 0.001), have stage IV disease (43.5 vs 30.1%; P = 0.017), and received no treatment (40.3 vs 18.4%; P < 0.001). When only comparing patients who underwent curative-intent resection at GMH (n = 23) to EUH (n = 137), median overall survival was similar between both groups (GMH: median not reached; EUH: 59.8 mos; P = 0.785). Conclusion: Although vulnerable patients with GAC within a safety-net hospital present with later stages of the disease, those who received surgery have acceptable outcomes. Thus, efforts should be made to overcome barriers in seeking care. K E Y W O R D S disparty, gastric cancer, safety-net

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“…6,7 In addition, the role of race/ethnicity differs in these studies, which have not reached a consistent conclusion. [8][9][10] Particularly, there is a lack of research analyzing stage at diagnosis, use of therapy, and prognosis among the leading cancers by race/ethnicity. Therefore, we included the 9 most common cancers in 1 analysis to test these differences, which could be helpful for optimizing treatments among patients from different racial/ethnic groups.…”

mentioning

confidence: 99%

Differences in Stage of Cancer at Diagnosis, Treatment, and Survival by Race and Ethnicity Among Leading Cancer Types

Zhang

Wang

et al. 2020

JAMA Netw Open

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IMPORTANCE Information about stage of cancer at diagnosis, use of therapy, and survival among patients from different racial/ethnic groups with 1 of the most common cancers is lacking. OBJECTIVE To assess stage of cancer at diagnosis, use of therapy, overall survival (OS), and cancerspecific survival (CSS) in patients with cancer from different racial/ethnic groups. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 950 377 Asian, black, white, and Hispanic patients who were diagnosed with prostate, ovarian, breast, stomach, pancreatic, lung, liver, esophageal, or colorectal cancers from January 2004 to December 2010. Data were collected using the Surveillance, Epidemiology, and End Results (SEER) database, and patients were observed for more than 5 years. Data analysis was conducted in July 2018. MAIN OUTCOMES AND MEASURES Multivariable logistic and Cox regression were used to evaluate the differences in stage of cancer at diagnosis, treatment, and survival among patients from different racial/ethnic groups. RESULTS A total of 950 377 patients (499 070 [52.5%] men) were included in the study, with 681 251 white patients (71.7%; mean [SD] age, 65 [12] years), 116 015 black patients (12.2%; mean [SD] age, 62 [12] years), 65 718 Asian patients (6.9%; mean [SD] age, 63 [13] years), and 87 393 Hispanic patients (9.2%; mean [SD] age, 61 [13] years). Compared with Asian patients, black patients were more likely to have metastatic disease at diagnosis (odds ratio [OR], 1.144; 95% CI, 1.109-1.180; P < .001). Black and Hispanic patients were less likely to receive definitive treatment than Asian patients

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Racial and ethnic disparities in gastric cancer outcomes: More important than surgical technique?

Cited by 33 publications

References 51 publications

Examining the gastric cancer survival gap between Asians and whites in the United States

Examining the gastric cancer survival gap between Asians and whites in the United States

Identifying the barriers to gastric cancer care at safety‐net hospitals: A novel comparison of a safety‐net hospital to a neighboring quaternary referral academic center in the same healthcare system

Differences in Stage of Cancer at Diagnosis, Treatment, and Survival by Race and Ethnicity Among Leading Cancer Types

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