title: Nativity, complications, and pathology are determinants of surgical results for gastric cancer.
abstract: BACKGROUND
  About half the patients involved in the current study were born outside of the United States. Epidemiologic and histologic features and survival estimates were compared with persons born in the United States. Results of gastrectomy with lymph node dissection were studied.
  
  
  METHODS
  Records of 187 patients with adenocarcinoma of the stomach were reviewed. Seventy-six with a curative gastrectomy were staged retrospectively. Univariate and multivariate analyses were done.
  
  
  RESULTS
  Seventy-six percent of histologically reviewed curative resections had the intestinal subtype with the same frequency in U.S.-born and foreign-born patients. Fewer patients with proximal third lesions were foreign born. Thirty-six percent had complications. The overall 5-year Kaplan-Meier survival estimate was 46%: 77% for patients with negative nodes and 33% for patients with positive nodes. N1 survival estimate was 44%; N2, 25%; N3(M1), 0%. All six patients with early gastric cancer are alive 50-147 months after surgery. Other stage I patients had estimated survival of 65%; Stage II, 52%; Stage III, 40%; and Stage IV, 0%. Multivariate analysis revealed four significant prognostic variables: nativity, histologic subgroup, presence of complications, and number of positive nodes.
  
  
  CONCLUSIONS
  Proximal gastric cancer was more common in U.S.-born persons. Gastric cancer may be more malignant in U.S.-born persons than in foreign-born persons because their survival was significantly poorer. Complications, a significant adverse factor, were more common in U.S. series. Pancreatectomy with gastrectomy is rarely indicated, because microscopic involvement is rare and complications frequent. The prognostic advantage of a regional lymphadenectomy remains unclear.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
authors.forename: J G
authors.initials: JG
authors.lastname: Fortner
authors.forename: G Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: H T
authors.initials: HT
authors.lastname: Thaler
authors.forename: R
authors.initials: R
authors.lastname: Concepcion
authors.forename: H
authors.initials: H
authors.lastname: Friedlander-Klar
authors.forename: U
authors.initials: U
authors.lastname: Kher
authors.forename: B J
authors.initials: BJ
authors.lastname: Maclean
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000208:ethnology / Q000473:pathology* / Q000601:surgery*; D017691:Caribbean Region / Q000208:ethnology; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D005006:Ethnicity; D005060:Europe / Q000208:ethnology; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000208:ethnology / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology