Ethnicity in Patterns/Presentation Gastric Adenocarcinoma

The effect of ethnicity on presentation, pattern of metastasis, and survival in gastric adenocarcinoma at a single center.

J. F. Tseng, P. F. Mansfield, B. W. Feig, P. W. Pisters, J. A. Ajani, J. C. Yao;

U Texas M. D. Anderson Cancer Center, Houston, TX

Abstract: Background: The effect of race/ethnicity in gastric cancer remains incompletely delineated.

Methods: 1920 patients with gastric adenocarcinoma who were treated at MD Anderson Cancer Center from 1985-1999 served as the study cohort.

Median survival duration was estimated by the Kaplan-Meier method. Cumulative survival was compared using the log-rank test. Self-identified race, AJCC stage, WHO histology, gastric subsite, age, and sex were entered into a Cox proportional hazards model for multivariate survival analysis.

Results: 1352 patients (70%) were white/Caucasian; 301 (16%) were Latino; 163 (8%) were African-American; 81 (4%) were Asian; 19 (2%) were unknown. 63% were men.

Gastric cancer location and stage varied by race (p<0.0005); Asians were more likely to have mid- or distal gastric involvement (62%, vs 42% for African-Americans, 18% for Latinos, 13% for whites), and less likely to have metastases (p=0.007) (AJCC Stage IV: 37% of Asians, 68% of African-Americans, 59% of Latinos, 56% of whites).

Of patients who had their first site of metastasis to either liver or peritoneal cavity (n=808), Asians were more likely than other groups to have peritoneal rather than liver metastasis (p=0.001).

White, Latino, and African-American patients had unadjusted median survivals less than half that of Asians (12.0, 10.8, and 10.5 months vs 26.7, respectively).

After adjusting for demographic and tumor characteristics, compared to whites, Latinos had a similar risk of death (HR 1.08, 95% CI 0.91-1.28), while African-Americans had an increased risk (HR 1.29, 95% CI 1.04-1.59, p=0.021) and Asians had a decreased risk of death (HR 0.70, 95% CI 0.50-0.96, p=0.028).

Conclusions: We report a large single-center experience with gastric adenocarcinoma in an ethnically diverse patient population.

After multivariable analysis, Latinos have equivalent survival to whites, whereas African-Americans demonstrate decreased and Asian have increased survival compared to all other races.

These differences were independent of stage, histology, tumor location, age, and gender. Factors contributing to these differences warrant further investigation.

Abstract No: 4016

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