Gastric Cancer

, Volume 22, Issue 3, pp 446–455 | Cite as

Nature versus nurture: the impact of nativity and site of treatment on survival for gastric cancer

  • Jessica L. Mueller
  • Danbee H. Kim
  • Sahael Stapleton
  • Christy E. Cauley
  • David C. Chang
  • Cho Hyun Park
  • Kyo Young SongEmail author
  • John T. Mullen
Original Article



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.


Gastric cancer Nativity Ethnicity Treatment Survival Outcomes 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical standards

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

Informed consent or substitute for it was obtained from all patients for being included in the study.


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Jessica L. Mueller
    • 1
    • 2
  • Danbee H. Kim
    • 2
  • Sahael Stapleton
    • 2
  • Christy E. Cauley
    • 2
  • David C. Chang
    • 2
  • Cho Hyun Park
    • 3
  • Kyo Young Song
    • 3
    Email author
  • John T. Mullen
    • 1
    • 2
  1. 1.Department of SurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  2. 2.Codman Institute for Clinical Effectiveness in SurgeryMassachusetts General HospitalBostonUSA
  3. 3.Department of Surgery, Seoul St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea

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