title: Treatment and outcomes of gastric cancer among United States-born and foreign-born Asians and Pacific Islanders.
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.
authors.affiliation: Division of Pharmacy, Department of Drug Use Policy and Pharmacoeconomics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. stacey@mgh-ita.org
authors.forename: Stacey A Dacosta
authors.initials: SA
authors.lastname: Byfield
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.forename: Ellen P
authors.initials: EP
authors.lastname: McCarthy
mesh_terms: D000368:Aged; D044466:Asian People; D005260:Female; D006801:Humans; D008297:Male; D044468:Native Hawaiian or Pacific Islander; D013274:Stomach Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States