Racial/ethnic differences in survival among gastric cancer patients in california

Abstract

Background

Gastric cancer is an important cause of death among racial/ethnic minorities in the U.S. The objective of this study was to investigate racial disparities in survival among gastric cancer patients within demographic and disease subgroups.

Methods

Patients diagnosed with invasive epithelial gastric cancer between 2006 and 2015 were identified from the California Cancer Registry. Cox proportional hazards regression was used to identify factors associated with survival among non-Hispanic whites (NHWs, n = 7,475), non-Hispanic blacks (NHBs, n = 1,246), Hispanics (n = 6,274), and Asians/Pacific Islanders (APIs, n = 4,204). Survival was compared across race/ethnicity within subgroups of demographic and disease factors. Five-year relative survival was also calculated within subgroups.

Results

There were notable differences in patient characteristics by race/ethnicity, but predictors of survival were similar for each group. Overall, APIs (HR = 0.83, 95% CI: 0.79, 0.88, p < 0.0001) and Hispanics (HR = 0.94, 95% CI: 0.90, 0.99, p = 0.0104) had better survival than NHWs, but NHBs and NHWs did not have different prognosis (HR = 1.06, 95% CI: 0.98, 1.15, p = 0.2237). The survival advantage of APIs persisted in nearly every demographic and disease subgroup, but Hispanics and NHBs had similar survival as NHWs in most groups. Race was not a significant predictor of survival among those with public or no insurance and patients with cardia tumors.

Conclusions

There are some differences in survival by race/ethnicity, but race/ethnicity alone cannot explain disparate outcomes in gastric cancer. Future studies, particularly ones that investigate the role of population-specific etiological factors and molecular tumor profiles, are needed to further understand factors associated with survival.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68:7–30. https://doi.org/10.3322/caac.21442

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    American Cancer Society (2018) Cancer Facts & Figures 2018

  3. 3.

    Marrelli D, Pedrazzani C, Roviello F (2010) Gastric cancer prognosis: strong correlation between incidence and survival. Ann Surg Oncol 17:340–341. https://doi.org/10.1245/s10434-009-0725-9

    Article  PubMed  Google Scholar 

  4. 4.

    Guggenheim DE, Shah MA (2013) Gastric cancer epidemiology and risk factors. J Surg Oncol 107:230–236. https://doi.org/10.1002/jso.23262

    Article  Google Scholar 

  5. 5.

    Corral JE, Delgado Hurtado JJ, Domínguez RL et al (2015) The descriptive epidemiology of gastric cancer in central america and comparison with united states hispanic populations. J Gastrointest Cancer 46:21–28. https://doi.org/10.1007/s12029-014-9672-1

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Merchant SJ, Li L, Kim J (2014) Racial and ethnic disparities in gastric cancer outcomes: more important than surgical technique? World J Gastroenterol WJG 20:11546–11551. https://doi.org/10.3748/wjg.v20.i33.11546

    Article  PubMed  Google Scholar 

  7. 7.

    Al-Refaie WB, Tseng JF, Gay G et al (2008) The impact of ethnicity on the presentation and prognosis of patients with gastric adenocarcinoma. Results from the National Cancer Data Base. Cancer 113:461–469. https://doi.org/10.1002/cncr.23572

    Article  PubMed  Google Scholar 

  8. 8.

    Kim J, Sun C-L, Mailey B et al (2010) Race and ethnicity correlate with survival in patients with gastric adenocarcinoma. Ann Oncol 21:152–160. https://doi.org/10.1093/annonc/mdp290

    Article  CAS  Google Scholar 

  9. 9.

    Lui FH, Tuan B, Swenson SL, Wong RJ (2014) Ethnic disparities in gastric cancer incidence and survival in the USA: an updated analysis of 1992–2009 SEER data. Dig Dis Sci 59:3027–3034. https://doi.org/10.1007/s10620-014-3275-3

    Article  PubMed  Google Scholar 

  10. 10.

    Jinjuvadia R, Jinjuvadia K, Liangpunsakul S (2013) Racial disparities in gastrointestinal cancers-related mortality in the us population. Dig Dis Sci 58:236–243. https://doi.org/10.1007/s10620-012-2312-3

    Article  PubMed  Google Scholar 

  11. 11.

    Marrelli D, Caruso S, Roviello F (2012) Prognostic factors and score systems in gastric cancer. In: de Manzoni G, Roviello F, Siquini W (eds) Surgery in the multimodal management of gastric cancer. Springer Milan, Milano, pp 35–42

    Google Scholar 

  12. 12.

    Kunz PL, Gubens M, Fisher GA et al (2012) Long-term survivors of gastric cancer: a California population-based study. J Clin Oncol Off J Am Soc Clin Oncol 30:3507–3515. https://doi.org/10.1200/JCO.2011.35.8028

    Article  Google Scholar 

  13. 13.

    Petrelli F, Ghidini M, Barni S et al (2017) Prognostic role of primary tumor location in non-metastatic gastric cancer: a systematic review and meta-analysis of 50 studies. Ann Surg Oncol 24:2655–2668. https://doi.org/10.1245/s10434-017-5832-4

    Article  PubMed  Google Scholar 

  14. 14.

    Duma N, Sanchez LJ, Castro YS et al (2016) Gastric adenocarcinoma: clinicopathologic differences among Hispanics and non-Hispanic whites. A single Institution’s experience over 14 years. Ann Gastroenterol Q Publ Hell Soc Gastroenterol 29:325–331. https://doi.org/10.20524/aog.2016.0030

    Article  Google Scholar 

  15. 15.

    Yao JC, Tseng JF, Worah S et al (2005) Clinicopathologic behavior of gastric adenocarcinoma in hispanic patients: analysis of a single institution’s experience over 15 years. J Clin Oncol 23:3094–3103. https://doi.org/10.1200/JCO.2005.08.987

    Article  PubMed  Google Scholar 

  16. 16.

    Wilkinson NW, Howe J, Gay G et al (2008) Differences in the pattern of presentation and treatment of proximal and distal gastric cancer: results of the 2001 gastric patient care evaluation. Ann Surg Oncol 15:1644–1650. https://doi.org/10.1245/s10434-008-9877-2

    Article  PubMed  Google Scholar 

  17. 17.

    McCann A Most & Least Diverse States in America. In: WalletHub. https://wallethub.com/edu/most-least-diverse-states-in-america/38262/. Accessed 19 Oct 2018

  18. 18.

    NAACCR Race and Ethnicity Work Group (2011) NAACCR Guideline for Enhancing Hispanic/Latino Identification: Revised NAACCR Hispanic/Latino Identification Algorithm [NHIA v2.2.1]

  19. 19.

    NAACCR Race and Ethnicity Work Group (2011) NAACCR Asian/Pacific Islander Identification Algorithm [NAPIIA v1.2.1]: Enhancing the Specificity of Identification

  20. 20.

    Yang J, Schupp C, Harrati A, et al (2014) Developing an area-based socioeconomic measure from American Community Survey data

  21. 21.

    Lauren P (1965) The two histological MAIN types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification. Acta Pathol Microbiol Scand 64:31–49

    Article  CAS  Google Scholar 

  22. 22.

    Wu H, Rusiecki JA, Zhu K et al (2009) Stomach carcinoma incidence patterns in the United States by histologic type and anatomic site. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol 18:1945–1952. https://doi.org/10.1158/1055-9965.EPI-09-0250

    Article  Google Scholar 

  23. 23.

    Henson DE, Dittus C, Younes M et al (2004) Differential trends in the intestinal and diffuse types of gastric carcinoma in the United States, 1973–2000: increase in the signet ring cell type. Arch Pathol Lab Med 128:765–770. https://doi.org/10.1043/1543-2165(2004)128%3c765:DTITIA%3e2.0.CO;2

    Article  Google Scholar 

  24. 24.

    Chang ET, Gomez SL, Fish K et al (2012) Gastric cancer incidence among Hispanics in California: patterns by time, nativity, and neighborhood characteristics. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol 21:709–719. https://doi.org/10.1158/1055-9965.EPI-11-1208

    Article  Google Scholar 

  25. 25.

    Sierra MS, Cueva P, Bravo LE, Forman D (2016) Stomach cancer burden in Central and South America. Cancer Epidemiol 44:S62–S73. https://doi.org/10.1016/j.canep.2016.03.008

    Article  PubMed  Google Scholar 

  26. 26.

    Gupta S, Tao L, Murphy JD et al (2019) Race/ethnicity-, socioeconomic status-, and anatomic subsite-specific risks for gastric cancer. Gastroenterology 156:59–62.e4. https://doi.org/10.1053/j.gastro.2018.09.045

    Article  PubMed  Google Scholar 

  27. 27.

    Jin H, Pinheiro PS, Callahan KE, Altekruse SF (2017) Examining the gastric cancer survival gap between Asians and whites in the United States. Gastric Cancer Off J Int Gastric Cancer Assoc Jpn Gastric Cancer Assoc 20:573–582. https://doi.org/10.1007/s10120-016-0667-4

    Article  Google Scholar 

  28. 28.

    Wang J, Sun Y, Bertagnolli MM (2015) Comparison of gastric cancer survival between caucasian and asian patients treated in the united states: results from the surveillance epidemiology and end results (seer) database. Ann Surg Oncol 22:2965–2971. https://doi.org/10.1245/s10434-015-4388-4

    Article  Google Scholar 

  29. 29.

    Theuer CP, Kurosaki T, Ziogas A et al (2000) Asian patients with gastric carcinoma in the United States exhibit unique clinical features and superior overall and cancer specific survival rates. Cancer 89:1883–1892

    Article  CAS  Google Scholar 

  30. 30.

    Sohn BH, Hwang J-E, Jang H-J, et al (2017) Clinical Significance of Four Molecular Subtypes of Gastric Cancer Identified by The Cancer Genome Atlas Project. Clin Cancer Res Off J Am Assoc Cancer Res. https://doi.org/10.1158/1078-0432.CCR-16-2211

  31. 31.

    Fang W-L, Huang K-H, Chang S-C, et al (2019) Comparison of the Clinicopathological Characteristics and Genetic Alterations Between Patients with Gastric Cancer with or Without Helicobacter pylori Infection. The Oncologist. https://doi.org/10.1634/theoncologist.2018-0742

  32. 32.

    Postlewait LM, Squires MH, Kooby DA et al (2016) Preoperative Helicobacter pylori Infection is Associated with Increased Survival After Resection of Gastric Adenocarcinoma. Ann Surg Oncol 23:1225–1233. https://doi.org/10.1245/s10434-015-4953-x

    Article  PubMed  Google Scholar 

  33. 33.

    Wang F, Sun GP, Zou YF et al (2013) Helicobacter pylori infection predicts favorable outcome in patients with gastric cancer. Curr Oncol 20:e388–e395. https://doi.org/10.3747/co.20.1417

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Kersulyte D, Mukhopadhyay AK, Velapatiño B et al (2000) Differences in genotypes of Helicobacter pylori from different human populations. J Bacteriol 182:3210–3218

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Falush D, Wirth T, Linz B et al (2003) Traces of human migrations in Helicobacter pylori populations. Science 299:1582–1585. https://doi.org/10.1126/science.1080857

    Article  CAS  Google Scholar 

  36. 36.

    Li G, Yu S, Xu J et al (2019) The prognostic role of Helicobacter pylori in gastric cancer patients: a meta-analysis. Clin Res Hepatol Gastroenterol 43:216–224. https://doi.org/10.1016/j.clinre.2018.08.012

    Article  PubMed  Google Scholar 

  37. 37.

    Taylor VM, Ko LK, Hwang JH et al (2014) Gastric cancer in asian american populations: a neglected health disparity. Asian Pac J Cancer Prev APJCP 15:10565–10571

    Article  PubMed  Google Scholar 

  38. 38.

    Torre LA, Goding Sauer AM, Chen MS et al (2016) Cancer Statistics for Asian Americans, Native Hawaiians, and Pacific Islanders, 2015: convergence of incidence between males and females. CA Cancer J Clin 66:182–202. https://doi.org/10.3322/caac.21335

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    U.S. Census Bureau QuickFacts: California. https://www.census.gov/quickfacts/ca. Accessed 14 Nov 2018

  40. 40.

    Karimi P, Islami F, Anandasabapathy S et al (2014) Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol 23:700–713. https://doi.org/10.1158/1055-9965.EPI-13-1057

    Article  Google Scholar 

Download references

Acknowledgments

The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute, Cancer Registry of Greater California. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors. LGC-C receives funding from COLCIENCIAS (grant 110565843382 - 204-2015), University of Tolima (projects 160114 and 160120516), University of California Davis (School of Medicine Dean’s Fellowship in Precision Health Equity; Office of the Provost funding for the Latino Cancer Health Equity Initiative), the National Institute of Environmental Health Sciences (Pilot grant from P30ES023513) and the National Cancer Institute (grants R01CA223978, R21CA199631, U54CA233306 and P30CA093373).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Amy K. Klapheke.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Klapheke, A.K., Carvajal-Carmona, L.G. & Cress, R.D. Racial/ethnic differences in survival among gastric cancer patients in california. Cancer Causes Control 30, 687–696 (2019). https://doi.org/10.1007/s10552-019-01184-0

Download citation

Keywords

  • Gastric cancer
  • Survival
  • Disparities
  • Race
  • Epidemiology