Skip to main content

Advertisement

SpringerLink
Log in

Overall Survival Is Impacted by Birthplace and Not Extent of Surgery in Asian Americans with Resectable Gastric Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Survival from gastric cancer in the USA still lags behind Asia. Genetic, environmental, and tumor biology differences, along with extent of surgery have been implicated. Our aim was to evaluate survival outcomes in Asian-American gastric cancer patients undergoing surgical resection by comparing place of birth and clinicopathologic characteristics (including evaluation of 15 lymph nodes).The Surveillance, Epidemiology, and End Results database was queried to identify patients treated surgically for gastric cancer with curative intent in the USA (2000–2010). US-born versus foreign-born Asian-American patients were analyzed for survival. Secondary comparison was made to non-Asian patients. Stage IV and non-surgical patients were excluded. Of 10,089 patients identified, 1467 patients were Asian: 271 were born in the USA, and 1196 were born outside the USA. Median survival was 32 months for non-Asians and 29 months for US-born Asians versus 61 months for Asian immigrants (p < 0.001). On multivariable analysis of overall survival in Asian patients, only US birthplace, older age, and higher stage yielded a significantly poorer outcome. Asian-American patients have a worse prognosis if born in the USA. Anatomic and surgical differences do not explain this disparity; environmental factors may be responsible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65:87–108.

    Article  PubMed  Google Scholar 

  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015;65:5–29.

    Article  PubMed  Google Scholar 

  3. Herrero R, Parsonnet J, Greenberg ER. Prevention of gastric cancer. JAMA 2014;312:1197–1198.

    Article  CAS  PubMed  Google Scholar 

  4. Choi KS, Jun JK, Suh M, Park B, Noh DK, Song SH, Jung KW, Lee HY, Choi IJ, Park EC. Effect of endoscopy screening on stage at gastric cancer diagnosis: results of the National Cancer Screening Programme in Korea. Br J Cancer 2015;112:608–612.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Wu CW, Hsiung CA, Lo SS, Hsieh MH, Chen JH, Li AF, Lui WY, Whang-Peng J. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 2006;7:309–315.

    Article  CAS  PubMed  Google Scholar 

  6. Park CH, Song KY, Kim SN. Treatment results for gastric cancer surgery: 12 years’ experience at a single institute in Korea. Eur J Surg Oncol 2008;34:36–41.

    Article  CAS  PubMed  Google Scholar 

  7. Tamura S, Takeno A, Miki H. Lymph node dissection in curative gastrectomy for advanced gastric cancer. Int J Surg Oncol 2011;2011:748745.

    PubMed Central  PubMed  Google Scholar 

  8. Lui FH, Tuan B, Swenson SL, Wong RJ. Ethnic disparities in gastric cancer incidence and survival in the USA: an updated analysis of 1992–2009 SEER data. Dig Dis Sci 2014;59:3027–3034.

    Article  PubMed  Google Scholar 

  9. Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol 2005;23:7114–7124.

    Article  PubMed  Google Scholar 

  10. Al-Refaie WB, Tseng JF, Gay G, Patel-Parekh L, Mansfield PF, Pisters PWT, Yao JC, Feig BW. The impact of ethnicity on the presentation and prognosis of patients with gastric adenocarcinoma. Results from the National Cancer Data Base. Cancer 2008;113:461–469.

    Article  PubMed  Google Scholar 

  11. Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol 2007;14:317–328.

    Article  PubMed  Google Scholar 

  12. Schwarz RE, Zagala-Nevarez K. Ethnic survival differences after gastrectomy for gastric cancer are better explained by factors specific for disease location and individual patient comorbidity. Eur J Surg Oncol 2002;28:214–219.

    Article  CAS  PubMed  Google Scholar 

  13. Hundahl SA, Phillips JL, Menck HR. The National Cancer Data Base Report on Poor Survival of U. S. Gastric Carcinoma Patients Treated with Gastrectomy; Fifth Edition American Joint Committee on Cancer Staging, Proximal Disease, and the “Different Disease” Hypothesis. Cancer 2000;88;921–932.

    Article  CAS  PubMed  Google Scholar 

  14. Wang X, Appleby DH, Zhang X, Gan L, Wang JJ, Wan F. Comparison of three lymph node staging schemes for predicting outcome in patients with gastric cancer. Br J Surg 2013;100:505–514.

    Article  CAS  PubMed  Google Scholar 

  15. 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;115:4595–4605.

    Article  PubMed  Google Scholar 

  16. Basaran H, Koca T, Cerkesli AK, Arslan D, Karaca S. Treatment Outcomes and Survival Study of Gastric Cancer Patients: A Retrospective Analysis in an Endemic Region. Asian Pac J Cancer Prev 2015;16:2055–2060.

  17. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 2010;17:3077–3079.

    Article  PubMed  Google Scholar 

  18. Nelson R, Ko EB, Arrington A, Lee W, Kim J, Garcia-Aguilar J, Kim J. Race and correlations between lymph node number and survival for patients with gastric cancer. J Gastrointest Surg 2013;17:471–481.

    Article  PubMed  Google Scholar 

  19. Deutsch GB, O’Connor V, Sim MS, Lee JH, Bilchik AJ. Incorporating surgical quality into the AJCC 7th edition improves staging accuracy in gastric cancer. Ann Surg Oncol 2015;22:11–16.

    Article  PubMed  Google Scholar 

  20. Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, Sydes M, Fayers P. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 1999;79:1522–1530.

    CAS  PubMed  Google Scholar 

  21. Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, Meyer S, Plukker JT, Van Elk P, Obertop H, Gouma DJ, van Lanschot JJ, Taat CW, de Graaf PW, von Meyenfeldt MF, Tilanus H. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999;340:908–914.

    Article  CAS  PubMed  Google Scholar 

  22. Songun I, Putter H, Kranenbarg EMK, Sasako M, van de Velde CJH. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 2010;11:439–449.

    Article  PubMed  Google Scholar 

  23. Wu CW, Hsiung CA, Lo SS, Hsieh MC, Shia LT, Whang-Peng J. Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg 2004;91:283–287.

    Article  CAS  PubMed  Google Scholar 

  24. Strong VE, Yoon SS. Extended lymphadenectomy in gastric cancer is debatable. World J Surg2013;37:1773–1777.

    Article  PubMed  Google Scholar 

  25. Ohtsu A, Yoshida S, Saijo N. Disparities in gastric cancer chemotherapy between the East and West. J Clin Oncol 2006;24:2188–2196.

    Article  PubMed  Google Scholar 

  26. Ohno S, Tomisaki S, Oiwa H, Sakaguchi Y, Ichiyoshi Y, Maehara Y, Sugimachi K. Clinicopathologic characteristics and outcome of adenocarcinoma of the human gastric cardia in comparison with carcinoma of other regions of the stomach. J Am Coll Surg 1995;180:577–582.

    CAS  PubMed  Google Scholar 

  27. Singh K, Ghoshal U. Causal role of Helicobacter pylori infection in gastric cancer: an Asian enigma. World J Gastroenterol 2006;12:1346–1351.

    PubMed Central  PubMed  Google Scholar 

  28. Plummer M, Franceschi S, Vignat J, Forman D, de Martel C. Global burden of gastric cancer attributable to Helicobacter pylori. Int J Cancer 2015;136:487–490.

    Article  CAS  PubMed  Google Scholar 

  29. Aghdam SM, Sardari Z, Safaralizadeh R, Bonyadi M, Abdolmohammadi R, Moghadam MS, Khalilnezhad A. Investigation of association between oipA and iceA1/iceA2 genotypes of Helicobacter pylori and gastric cancer in Iran. Asian Pac J Cancer Prev 2014;15:8295–8299.

    Article  PubMed  Google Scholar 

  30. Kawai M, Furuta Y, Yahara K, Tsuru T, Oshima K, Handa N, Takahashi N, Yoshida M, Azuma T, Hattori M. Evolution in an oncogenic bacterial species with extreme genome plasticity: Helicobacter pylori East Asian genomes. BMC Microbiol 2011;11:104.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Machida-Montani A, Sasazuki S, Inoue M, Natsukawa S, Shaura K, Koizumi Y, Kasuga Y, Hanaoka T, Tsugane S. Association of Helicobacter pylori infection and environmental factors in non-cardia gastric cancer in Japan. Gastric Cancer 2004;7:46–53.

    Article  PubMed  Google Scholar 

  32. Chuah B, Goh BC, Lee SC, Soong R, Lau F, Mulay M, Dinolfo M, Lim SE, Soo R, Furuie T, Saito K, Zergebel C, Rosen LS. Comparison of the pharmacokinetics and pharmacodynamics of S-1 between Caucasian and East Asian patients. Cancer Sci 2011;102:478–483.

    Article  CAS  PubMed  Google Scholar 

  33. Gilbert SM, Hollenbeck BK. Limitations of lymph node counts as a measure of therapy. J Natl Compr Canc Netw 2009;7:58–61.

    PubMed  Google Scholar 

  34. Anderson WF, Camargo MC, Fraumeni JF, Correa P, Rosenberg PS, Rabkin CS. Age-specific trends in incidence of noncardia gastric cancer in US adults. JAMA 2010;303:1723–1728.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Supported by funding from the California Oncology Research Institute, Los Angeles, CA, and by fellowship funding from The Harold McAlister Charitable Foundation, Los Angeles, CA (Dr. Kirchoff). We would like to thank Ms. Gwen Berry at the John Wayne Cancer Institute for her editorial assistance with this manuscript.

Author information

Authors and Affiliations

  1. John Wayne Cancer Institute at Providence St. John’s Health Center, Santa Monica, CA, USA

    Daniel D. Kirchoff, Gary B. Deutsch, Manabu Fujita, David Y. Lee, Ji Hey Lee & Anton J. Bilchik

  2. University of California at Los Angeles, DOMSTAT, Los Angeles, CA, USA

    Myung Shin Sim

  3. California Oncology Research Institute, Los Angeles, CA, USA

    Anton J. Bilchik

Authors
  1. Daniel D. Kirchoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gary B. Deutsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Manabu Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Y. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Myung Shin Sim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ji Hey Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anton J. Bilchik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anton J. Bilchik.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kirchoff, D.D., Deutsch, G.B., Fujita, M. et al. Overall Survival Is Impacted by Birthplace and Not Extent of Surgery in Asian Americans with Resectable Gastric Cancer. J Gastrointest Surg 19, 1966–1973 (2015). https://doi.org/10.1007/s11605-015-2919-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-015-2919-8

Keywords

Search

Navigation