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Race and Correlations Between Lymph Node Number and Survival for Patients with Gastric Cancer

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

There is ongoing debate whether extended lymphadenectomy improves survival in gastric cancer patients who undergo surgical resection. We previously observed that Korean–American patients had the highest overall survival in Los Angeles County. Our objective was to assess lymph node (LN) number and its impact on survival for Korean–American gastric cancer patients.

Methods

We utilized the National Cancer Institute’s Surveillance, Epidemiology, and End Results registry to identify Korean–Americans with gastric adenocarcinoma treated with curative-intent gastrectomy between 1988 and 2008. We grouped patients according to examined LN number (1–15 and 16+) and compared characteristics. We performed similar analysis for white patients.

Results

Out of 982 Korean–American patients with gastric adenocarcinoma, most patients had 1–15 examined LNs (60 %). When we compared LN groups, we observed higher overall survival in the 1–15 group than the 16+ group (5-year survival, 59 % vs 52 %, respectively; p = 0.04). However, LN number was not prognostic of overall survival on stepwise Cox proportional hazards analysis. In contrast, LN number was prognostic for white patients.

Conclusions

Although examined LN number may impact survival for white patients, outcomes of Korean–American gastric cancer patients were independent of LN number. Our data suggest that survival of Korean–American gastric cancer patients are comparable with outcomes from East Asian hospitals and may be independent of surgical technique.

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References

  1. Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol 2006;12:354–362.

    PubMed  Google Scholar 

  2. 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 

  3. Park JM, Kim YH. Current approaches to gastric cancer in Korea. Gastrointest Cancer Res 2008;2:137–144.

    PubMed  Google Scholar 

  4. Strong VE, Song KY, Park CH, et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg 2010;251:640–646.

    Article  PubMed  Google Scholar 

  5. Davis PA, Sano T. The difference in gastric cancer between Japan, USA and Europe: what are the facts? what are the suggestions? Crit Rev Oncol Hematol 2001;40:77–94.

    Article  PubMed  CAS  Google Scholar 

  6. Adachi Y, Kitano S, Sugimachi K. Surgery for gastric cancer: 10-year experience worldwide. Gastric Cancer 2001;4:166–174.

    Article  PubMed  CAS  Google Scholar 

  7. Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H. Surgical treatment for gastric cancer: the Japanese approach. Semin Oncol 1996;23:360–368.

    PubMed  CAS  Google Scholar 

  8. Wu CW, Hsiung CA, Lo SS, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 2006;7:309–315.

    Article  PubMed  CAS  Google Scholar 

  9. Di Leo A, Marrelli D, Roviello F, et al. Lymph node involvement in gastric cancer for different tumor sites and T stage: Italian Research Group for Gastric Cancer (IRGGC) experience. J Gastrointest Surg 2007;11:1146–1153.

    Article  PubMed  Google Scholar 

  10. Tamura S, Takeno A, Miki H. Lymph node dissection in curative gastrectomy for advanced gastric cancer. International Journal of Surgical Oncology 2011:Article 748745.

  11. 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  PubMed  CAS  Google Scholar 

  12. 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  PubMed  CAS  Google Scholar 

  13. Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999;340:908–914.

    Article  PubMed  CAS  Google Scholar 

  14. Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 2004;22:2069–2077.

    Article  PubMed  CAS  Google Scholar 

  15. Cuschieri A, Weeden S, Fielding J, et al. 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.

    Article  PubMed  CAS  Google Scholar 

  16. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. 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 

  17. Kim J, Sun CL, Mailey B, et al. Race and ethnicity correlate with survival in patients with gastric adenocarcinoma. Ann Oncol 2010;21:152–160.

    Article  PubMed  CAS  Google Scholar 

  18. Kim J, Mailey B, Senthil M, Artinyan A, Sun CL, Bhatia S. Disparities in gastric cancer outcomes among Asian ethnicities in the USA. Ann Surg Oncol 2009;16:2433–2441.

    Article  PubMed  Google Scholar 

  19. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001;345:725–730.

    Article  PubMed  CAS  Google Scholar 

  20. van de Velde CJ. Resection for gastric cancer in the community. Semin Oncol 2005;32:S90–S93.

    Article  PubMed  Google Scholar 

  21. Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007;357:1810–1820.

    Article  PubMed  CAS  Google Scholar 

  22. Lee JH, Ryu KW, Park SR, et al. Learning curve for total gastrectomy with D2 lymph node dissection: cumulative sum analysis for qualified surgery. Ann Surg Oncol 2006;13:1175–1181.

    Article  PubMed  Google Scholar 

  23. National Cancer Institute. Overview of the SEER Program. 2011. (Accessed January 15, 2012, at http://seer.cancer.gov/about/overview.html.)

  24. Karpeh MS, Leon L, Klimstra D, Brennan MF. Lymph node staging in gastric cancer: is location more important than Number? An analysis of 1,038 patients. Ann Surg 2000;232:362–371.

    Article  PubMed  CAS  Google Scholar 

  25. Ajani J, Barthel J, Bekaii-Saab T, et al. NCCN Clinical Practice Guidelines in Oncology: Gastric Cancer. J Natl Compr Canc Netw 2010;8:378–409.

    PubMed  CAS  Google Scholar 

  26. de Aretxabala X, Konishi K, Yonemura Y, et al. Node dissection in gastric cancer. Br J Surg 1987;74:770–773.

    Article  PubMed  Google Scholar 

  27. Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg 1987;11:418–425.

    Article  PubMed  CAS  Google Scholar 

  28. Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 2004;54:78–93.

    Article  PubMed  Google Scholar 

  29. Miller B, Kolonel L, Bernstein L, et al. Racial/Ethnic Patterns of Cancer in the United States 1988–1992. Bethesda, MD; 1996.

  30. Morris AM, Rhoads KF, Stain SC, Birkmeyer JD. Understanding racial disparities in cancer treatment and outcomes. J Am Coll Surg 2010;211:105–113.

    Article  PubMed  Google Scholar 

  31. Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 2008;359:453–462.

    Article  PubMed  CAS  Google Scholar 

  32. Theuer CP, Kurosaki T, Ziogas A, Butler J, Anton-Culver H. Asian patients with gastric carcinoma in the United States exhibit unique clinical features and superior overall and cancer specific survival rates. Cancer 2000;89:1883–1892.

    Article  PubMed  CAS  Google Scholar 

  33. Ramadori G, Triebel J. Nodal dissection for gastric cancer. N Engl J Med 2008;359:2392; author reply 3.

  34. Stessin AM, Sherr DL. Demographic disparities in patterns of care and survival outcomes for patients with resected gastric adenocarcinoma. Cancer Epidemiol Biomarkers Prev 2011;20:223–233.

    Article  PubMed  Google Scholar 

  35. Le A, Berger D, Lau M, El-Serag HB. Secular trends in the use, quality, and outcomes of gastrectomy for noncardia gastric cancer in the United States. Ann Surg Oncol 2007;14:2519–2527.

    Article  PubMed  Google Scholar 

  36. Chen MS, Jr. Cancer health disparities among Asian Americans: what we do and what we need to do. Cancer 2005;104:2895–2902.

    Article  PubMed  Google Scholar 

  37. Gill S, Shah A, Le N, Cook EF, Yoshida EM. Asian ethnicity-related differences in gastric cancer presentation and outcome among patients treated at a canadian cancer center. J Clin Oncol 2003;21:2070–2076.

    Article  PubMed  Google Scholar 

  38. Lee HJ, Yang HK, Ahn YO. Gastric cancer in Korea. Gastric Cancer 2002;5:177–182.

    Article  PubMed  Google Scholar 

  39. Kwong SL, Chen MS, Jr., Snipes KP, Bal DG, Wright WE. Asian subgroups and cancer incidence and mortality rates in California. Cancer 2005;104:2975–2981.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Presented in part at the 9th International Gastric Cancer Congress, Seoul, South Korea, April 2011.

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Authors and Affiliations

  1. Departments of Biostatistics (RN) and Surgery (EBK, AA, WL, JK, JK), City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91010, USA

    Rebecca Nelson, Eun Bi Ko, Amanda Arrington, Wendy Lee, Jae Kim, Julio Garcia-Aguilar & Joseph Kim

  2. Department of Surgery (JGA), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Rebecca Nelson, Eun Bi Ko, Amanda Arrington, Wendy Lee, Jae Kim, Julio Garcia-Aguilar & Joseph Kim

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  1. Rebecca Nelson
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  2. Eun Bi Ko
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  7. Joseph Kim
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Correspondence to Joseph Kim.

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Nelson, R., Ko, E.B., Arrington, A. et al. Race and Correlations Between Lymph Node Number and Survival for Patients with Gastric Cancer. J Gastrointest Surg 17, 471–481 (2013). https://doi.org/10.1007/s11605-012-2125-x

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  • DOI: https://doi.org/10.1007/s11605-012-2125-x

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