Skip to main content
SpringerLink
Log in

Race/Ethnicity Is Predictive of Lymph Node Status in Patients with Early Gastric Cancer

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

Abstract

Background

Race/ethnicity has long been suspected to affect survival in patients with gastric adenocarcinoma. However, the clinicohistopathological impact of race or ethnicity on early gastric cancer (EGC) is not known.

Methods

From 2000 to 2013, 286 patients underwent gastrectomy and 104 patients had pathological confirmation of EGC. A retrospective analysis of pathological and clinical prognostic indicators was performed.

Results

The study population consisted of 38 (37 %) Asian Americans and 66 (63 %) non-Asian Americans. Of these, 2 (5.3 %) Asian Americans and 19 (28.8 %) non-Asian Americans had pathological confirmation of lymph node metastasis (LNM) (p = 0.004). Univariate analysis comparing the clinicohistopathological characteristics in each group did not reveal significant difference regarding histotype, tumor size, grade, location, morphology, or lymphovascular invasion, except for the LNM rate and mean body mass index (23.2 versus 26.6, p < 0.001). Multivariate analysis showed that non-Asian race/ethnicity (odds ratio (OR), 9.09; 95 % confidence interval (CI), 1.12–71.43; p = 0.038), younger age (OR, 1.11; 95 % CI, 1.01–1.12; p = 0.046), and lymphovascular invasion (OR, 13.9; 95 % CI, 2.40–79.99; p = 0.003) were significant predictors for LNM.

Conclusions

This study demonstrated that Asian American race in EGC is associated with a significantly decreased rate of LNM in comparison to non-Asian Americans, despite similar histopathological characteristics of each group.

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

Similar content being viewed by others

References

  1. Carter KJ, Schaffer HA, Ritchie WP. Early gastric cancer. Ann Surg 1984;199:604–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  2. Murakami T. Early cancer of the stomach. World J Surg. 1979;3:685–92.

    Article  PubMed  CAS  Google Scholar 

  3. 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;89:1883–92.

    Article  PubMed  CAS  Google Scholar 

  4. Kim J, Sun CL, Mailey B, Prendergast C, Artinyan A, Bhatia S, Pigazzi A, Ellenhorn JD. Race and ethnicity correlate with survival in patients with gastric adenocarcinoma. Ann Oncol. 2010;21:152–60.

    Article  PubMed  CAS  Google Scholar 

  5. 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;21:2070–6.

    Article  PubMed  Google Scholar 

  6. Leung WK, Wu MS, Kakugawa Y, Kim JJ, Yeoh KG, Goh KL, Wu KC, Wu DC, Sollano J, Kachintorn U, Gotoda T, Lin JT, You WC, Ng EK, Sung JJ. Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol. 2008;9:279–87.

    Article  PubMed  Google Scholar 

  7. Schlemper RJ, Itabashi M, Kato Y, Lewin KJ, Riddell RH, Shimoda T, Sipponen P, Stolte M, Watanabe H, Takahashi H, Fujita R. Differences in diagnostic criteria for gastric carcinoma between Japanese and western pathologists. Lancet. 1997;349:1725–9.

    Article  PubMed  CAS  Google Scholar 

  8. Brar S, Law C, McLeod R, Helyer L, Swallow C, Paszat L, Seevaratnam R, Cardoso R, Dixon M, Mahar A, Lourenco LG, Yohanathan L, Bocicariu A, Bekaii-Saab T, Chau I, Church N, Coit D, Crane CH, Earle C, Mansfield P, Marcon N, Miner T, Noh SH, Porter G, Posner MC, Prachand V, Sano T, van de Velde C, Wong S,Coburn N. Defining surgical quality in gastric cancer: a RAND/UCLA appropriateness study. J Am Coll Surg. 2013;217:347–57.

    Article  PubMed  Google Scholar 

  9. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer. 2000;3:219–25.

    Article  PubMed  Google Scholar 

  10. Fukami N. ESD Around the World: United States. Gastrointest Endosc Clin N Am. 2014;24:313–320.

    Article  PubMed  Google Scholar 

  11. American Joint Committee on Cancer. Cancer staging manual. 7th ed. Chicago: Springer; 2010.

    Book  Google Scholar 

  12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Strong VE, Song KY, Park CH, Jacks LM, Gonen M, Shah M, Coit DG, Brennan MF. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg. 2010;251:640–6.

    Article  PubMed  Google Scholar 

  14. 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  PubMed Central  Google Scholar 

  15. Theuer CP. Asian gastric cancer patients at a southern California comprehensive cancer center are diagnosed with less advanced disease and have superior stage-stratified survival. Am Surg. 2000;66:821–826.

    PubMed  CAS  Google Scholar 

  16. Noguchi Y, Imada T, Matsumoto A, Coit DG, Brennan MF. Radical surgery for gastric cancer. A review of the Japanese experience. Cancer. 1989;64:2053–2062.

    Article  PubMed  CAS  Google Scholar 

  17. 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;28:214–9.

    Article  PubMed  CAS  Google Scholar 

  18. Bollschweiler E, Boettcher K, Hoelscher AH, Sasako M, Kinoshita T, Maruyama K, Siewert JR. Is the prognosis for Japanese and German patients with gastric cancer really different? Cancer. 1993;71:2918–25.

    Article  PubMed  CAS  Google Scholar 

  19. Yao JC, Schnirer II, Reddy S, Chiang S, Najam A, Yu C, Giacco G, Hess K, Rashid A, Xie K, Lynch P, Ajani JA. Effects of sex and racial/ethnic group on the pattern of gastric cancer localization. Gastric Cancer. 2002;5:208–12.

    Article  PubMed  Google Scholar 

  20. Schlemper RJ, Kato Y, Stolte M. Review of histological classifications of gastrointestinal epithelial neoplasia: differences in diagnosis of early carcinomas between Japanese and Western pathologists. J Gastroenterol. 2001;36:445–56.

    Article  PubMed  CAS  Google Scholar 

  21. Bunt AM, Hermans J, Smit VT, van de Velde CJ, Fleuren GJ, Bruijn JA. Surgical/pathologic-stage migration confounds comparisons of gastric cancer survival rates between Japan and Western countries. J Clin Oncol. 1995;13:19–25.

    PubMed  CAS  Google Scholar 

  22. Kodera Y. Surgery for gastric cancer: Has the East versus West issue been solved? Dig Surg. 2013;30:92–5.

    Article  PubMed  Google Scholar 

  23. Hochwald SN, Brennan MF, Klimstra DS, Kim S, Karpeh MS. Is lymphadenectomy necessary for early gastric cancer? Ann Surg Oncol. 1999;6:664–70.

    Article  PubMed  CAS  Google Scholar 

  24. Seto Y, Nagawa H, Muto T. Impact of lymph node metastasis on survival with early gastric cancer. World J Surg. 1997;21:186–9.

    Article  PubMed  CAS  Google Scholar 

  25. Li H, Lu P, Lu Y, Liu C, Xu H, Wang S, Chen J. Predictive factors of lymph node metastasis in undifferentiated early gastric cancers and application of endoscopic mucosal resection. Surg Oncol. 2010;19:221–6.

    Article  PubMed  Google Scholar 

  26. Smith BR, Stabile BE. Extreme aggressiveness and lethality of gastric adenocarcinoma in the very young. Arch Surg. 2009;144:506–10.

    Article  PubMed  Google Scholar 

  27. Bickenbach KA, Denton B, Gonen M, Brennan MF, Coit DG, Strong VE. Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer. Ann Surg Oncol. 2013;20:780–7.

    Article  PubMed  Google Scholar 

  28. Sugimoto M, Kinoshita T, Shibasaki H, Kato Y, Gotohda N, Takahashi S, Konishi M. Short-term outcome of total laparoscopic distal gastrectomy for overweight and obese patients with gastric cancer. Surg Endosc. 2013;27:4291–6.

    Article  PubMed  Google Scholar 

  29. Lin YS, Huang KH, Lan YT, Fang WL, Chen JH, Lo SS, Hsieh MC, Li AF, Chiou SH, Wu CW. Impact of body mass index on postoperative outcome of advanced gastric cancer after curative surgery. J Gastrointest Surg. 2013;17:1382–91.

    Article  PubMed  Google Scholar 

  30. Griffin SM. Gastric cancer in the East: same disease, different patient. Br J Surg. 2005;92:1055–6.

    Article  PubMed  CAS  Google Scholar 

  31. Strong VE, Song KY, Park CH, Jacks LM, Gonen M, Shah MA, Coit DG, Brennan MF. Comparison of disease-specific survival in the United States and Korea after resection for early-stage node-negative gastric carcinoma. J Surg Oncol. 2013;107:634–40.

    Article  PubMed  Google Scholar 

  32. 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;17:471–81.

    Article  PubMed  Google Scholar 

  33. 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;16:2433–41.

    Article  PubMed  Google Scholar 

  34. Coman RM, Gotoda T, Draganov PV. Training in endoscopic submucosal dissection. World J Gastrointest Endosc. 2013;5:369–78.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Conflict of Interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Beth Israel Medical Center, First Ave. 16th St., New York, NY, 10003, USA

    Shinichi Fukuhara, Marissa M. Montgomery, Steven T. Brower & Martin S. Karpeh Jr

  2. Department of Pathology, Beth Israel Medical Center, New York, NY, USA

    Mariko Yabe

  3. Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, NY, USA

    Shinobu Itagaki

Authors
  1. Shinichi Fukuhara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mariko Yabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marissa M. Montgomery
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shinobu Itagaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steven T. Brower
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Martin S. Karpeh Jr
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shinichi Fukuhara.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fukuhara, S., Yabe, M., Montgomery, M.M. et al. Race/Ethnicity Is Predictive of Lymph Node Status in Patients with Early Gastric Cancer. J Gastrointest Surg 18, 1744–1751 (2014). https://doi.org/10.1007/s11605-014-2590-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-014-2590-5

Keywords

Search

Navigation