Nature versus nurture: the impact of nativity and site of treatment on survival for gastric cancer
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The prognosis of gastric cancer patients is better in Asia than in the West. Genetic, environmental, and treatment factors have all been implicated. We sought to explore the extent to which the place of birth and the place of treatment influences survival outcomes in Korean and US patients with localized gastric cancer.
Patients with localized gastric adenocarcinoma undergoing potentially curative gastrectomy from 1989 to 2010 were identified from the SEER registry and two single institution databases from the US and Korea. Patients were categorized into three groups: Koreans born/treated in Korea (KK), Koreans born in Korea/treated in the US (KUS), and White Americans born/treated in the US (W), and disease-specific survival rates compared.
We identified 16,622 patients: 3,984 (24.0%) KK, 1,046 (6.3%) KUS, and 11,592 (69.7%) W patients. KK patients had longer unadjusted median (not reached) and 5-year disease-specific survival (81.6%) rates than KUS (87 months, 55.9%) and W (35 months, 39.2%; p < 0.001 for all comparisons) patients. This finding persisted on subset analyses of patients with stage IA tumors, without cardia/GEJ tumors, with > 15 examined lymph nodes, and treated at a US center of excellence. On multivariable analysis, KUS (HR 2.80, p < 0.001) and W (HR 5.79, p < 0.001) patients had an increased risk of mortality compared to KK patients.
Both the place of birth and the place of treatment significantly contribute to the improved prognosis of patients with gastric cancer in Korea relative to those in the US, implicating both nature and nurture in this phenomenon.
KeywordsGastric cancer Nativity Ethnicity Treatment Survival Outcomes
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.
Informed consent or substitute for it was obtained from all patients for being included in the study.
- 1.World Health Organization. Cancer. Geneva: World Health Organization; 2017.Google Scholar
- 12.Shim JH, Song KY, Jeon HM, et al. Is gastric cancer different in Korea and the United States? Impact of tumor location on prognosis. Ann Surg Oncol 21: 2332–2339.Google Scholar
- 18.Howard JH, Hiles JM, Leung AM, et al. Race influences stage-specific survival in gastric cancer. Am Surg. 2015;81:259–67.Google Scholar
- 35.International Migration Report. New York: United Nations; 2015.Google Scholar