Asian gastric cancer patients at a southern California comprehensive cancer center are diagnosed with less advanced disease and have superior stage-stratified survival.
The 5-year overall survival after curative gastrectomy for gastric cancer is markedly different in the West from that in the Far East. Japanese surgeons feel that extended lymphadenectomy contributes to this superior survival, although survival differences may reflect improved staging or less aggressive tumor biology. We analyzed consecutive cases of gastric adenocarcinoma diagnosed and treated at the University of California, Irvine Medical Center from 1989 through 1998 to determine whether patients of Asian descent diagnosed with gastric cancer in Southern California have improved outcome. Fifty-two cases (36%) occurred in patients of Asian descent (39% Vietnamese, 31% Chinese, 13% Korean, 6% Filipino, and 2% Japanese). Only one Asian patient was born in the United States. Non-Asian patients (67% white, 30% Latino, and 3% black) were younger (59 years vs 64 years; P < 0.05) and more likely to have tumors of the gastroesophageal junction (33% vs 4%; P < 0.001). Asian patients were less likely to have distant metastases (24% vs 39%; P = 0.08), were more likely to undergo formal gastrectomy (71% vs 45%; P < 0.01), and were more likely to undergo a curative resection (40% vs 18%; P < 0.01). The overall survival of Asian patients at 3 years was significantly higher than the overall survival of non-Asians (39.4% vs 19.6%, P < 0.05). Asians with regional (node-positive) disease had superior survival (40.2% vs 14.8%, P < 0.05), which can be largely attributed to greater rates of resectability. We conclude that the clinical behavior of gastric cancer in Asians in Southern California differs from that in non-Asians. The increased proportion of resectable disease and improved survival of patients of Asian descent likely reflects less aggressive tumor biology.
Theuer
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Department of Surgery, University of California, Irvine, USA.
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000208:ethnology / Q000473:pathology / Q000556:secondary / Q000601:surgery; D000367:Age Factors; D001213:Asian; D044466:Asian People; D002140:California; D002681:China / Q000208:ethnology; D004938:Esophageal Neoplasms / Q000175:diagnosis; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D005743:Gastrectomy; D006630:Hispanic or Latino; D006801:Humans; D007723:Korea / Q000208:ethnology; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D014744:Vietnam / Q000208:ethnology; D044465:White People