The impact of ethnicity on the presentation and prognosis of patients with gastric adenocarcinoma

Al‐Refaie, Waddah B.; Tseng, Jennifer F.; Patel-Parekh, Lina; Mansfield, Paul F.; Pisters, Peter W.T.; Yao, James C.; Feig, Barry W.

doi:10.1002/cncr.23572

Cited by 74 publications

(76 citation statements)

References 32 publications

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“…The incidences of different subtypes of gastric cancers (intestinal type vs. diffuse type, non-cardiac location vs. cardiac/gastroesophageal junctional location) differ between Asian and non-Asian populations. These different subtypes of gastric cancers are associated with different risk factors, clinical presentation, and treatment outcomes [14][15][16][17]. Therefore, clinical trials conducted in different regions of the world may enroll patients with heterogeneous biological backgrounds that make the trial results not comparable.…”

Section: Introductionmentioning

confidence: 99%

Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: a meta-analysis and meta-regression

et al. 2012

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Background The standard of chemotherapy regimens for advanced or metastatic gastric cancer and the clinical outcome were heterogeneous in Asian versus non-Asian countries. This study aimed to explore predictors of safety and efficacy of chemotherapy for patients with advanced or metastatic gastric cancer. Methods Treatment group-based meta-analysis and metaregression were performed to analyze results of randomized trials published since 2005 for advanced or metastatic gastric cancer patients who received systemic chemotherapy as first-line treatment. Data were extracted and synthesized according to the Cochrane guidelines. Results Twenty-five trials (8 Asian, 17 Western or international) with 56 treatment groups were analyzed.Asian trials reported a lower percentage of gastroesophageal junctional carcinoma, higher percentage of diffusetype histology, and more frequent use of second-line chemotherapy. Meta-analysis revealed significant heterogeneity both in treatment safety (grade 3-4 neutropenia and diarrhea) and efficacy [6-month progression-free survival (PFS) and 1-year overall survival (OS)]. Meta-regression analyses indicate that Asian trials are associated with an 8.2% lower incidence of grade 3-4 neutropenia and 2.1% lower incidence of grade 3-4 diarrhea. A lower percentage of patients with gastroesophageal junction carcinoma and the use of combination regimens predicted better PFS. The use of second-line chemotherapy predicts better 1-year OS, which will increase by 10% for every 10% increase in patients who received second-line chemotherapy. Conclusion Geographic region (Asian vs. non-Asian) is an independent predictor of safety in systemic therapy for gastric cancer.C. Hsu and Y.-C. Shen contributed equally to this work.Electronic supplementary material The online version of this article

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Section: Introductionmentioning

confidence: 99%

Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: a meta-analysis and meta-regression

et al. 2012

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“…Multiple studies have examined ethnicityrelated differences in survival after gastrectomy, showing prognoses to be superior for Asian and Hispanic patients over their Caucasian and African-American counterparts (17)(18)(19)(20)(21)(22)(23). This trend has been attributed to differences in patterns of disease presentation (i.e., proximal versus distal tumor location), and cultural differences in life style and social habits (17)(18)(19)(20)(21)(22). Interestingly, 2 studies found that patterns of tumor localization among Asians were more similar to the patterns among African Americans than among Caucasians (20)(21).…”

Section: Discussionmentioning

confidence: 99%

Demographic Disparities in Patterns of Care and Survival Outcomes for Patients with Resected Gastric Adenocarcinoma

Stessin

Sherr

2011

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Several reports showed incomplete adoption of adjuvant radiotherapy (RT) for resectable gastric cancer since the publication of Intergroup 0116 trial results. The aims of this study were to identify demographic factors associated with omission of adjuvant RT and assess the impact of this omission on survival.Methods: SEER database was queried for cases of resected gastric cancer. Multivariate analyses with logistic and Cox regressions were used to examine (a) likelihood of receiving adjuvant RT for different patient and county demographics and (b) effect of demographics on survival outcomes.Results: A total of 7,348 patients met the study criteria. Adjuvant RT was used in 33.1% of cases diagnosed in 1998-2001 and in 45.3% of cases in 2002-2007 (P < 0.001). Controlling for independent covariates, African Americans were 8.9% less likely to receive adjuvant RT than Caucasians or Asians (P < 0.001). Correspondingly, overall survival rates were significantly lower for African Americans than other races (HR ¼ 1.38, P < 0.001). Furthermore, both the likelihood of receiving RT and the survival rates were significantly affected by county demographics: percent of population without high school education, percent of households below the poverty line, and median household income. Survival rates were highest among Asians, but this finding did not reflect more frequent use of RT.Conclusions: Race and socioeconomic factors are significant predictors of treatment and survival outcomes for patients with resectable gastric cancer.Impact: The findings of this and similar studies may aide the medical community in designing more effective strategies to ameliorate the standards of care nationwide. Cancer Epidemiol Biomarkers Prev; 20(2); 223-33.

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“…[8][9][10][11][12] We also demonstrated that race has an impact on patterns of disease presentation and survival rates in the United States. 8 For example, African Americans and Hispanics were more likely than other races to present with AJCC stage III or IV disease and to receive no adjuvant therapy. Although advanced stage at presentation is not an unusual feature of gastric cancer in the West, these findings also suggest that ethnicity may influence whether a patient receives adequate treatment for gastric adenocarcinoma.…”

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confidence: 95%

Variations in gastric cancer care

Al‐Refaie

Virnig

Tseng

et al. 2009

Cancer

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BACKGROUND:Race is associated with patterns of presentation and survival outcomes of gastric cancer in the United States. However, the impact of race on the receipt of guideline‐recommended care is not well characterized. By using current recommendations, the authors examined the association between race and guideline‐recommended treatments and identified factors that are predictive of variations in gastric cancer care.METHODS:By using the National Cancer Database for 1998 through 2005, 106,002 patients with gastric adenocarcinoma were identified. Multivariate analysis techniques were used to examine the association between race, the receipt of guideline‐recommended care, and survival after adjusting for covariates.RESULTS:Although African‐American and Hispanic patients were more likely to undergo adequate lymphadenectomy (≥15 lymph nodes) and to receive care at comprehensive cancer centers and high‐volume facilities (for all, P ≤ .001), they were less likely to receive adjuvant multimodality therapy for American Joint Committee on Cancer stage IB through IV, lymph node‐negative (M0) disease. Up to 60% of all patients who underwent gastrectomy failed to receive adequate lymphadenectomy and adjuvant multimodality therapy. The delivery of multimodality therapy varied significantly by stage and lymph node evaluation (P ≤ .001). These findings persisted on our multivariate analyses, indicating that African‐American and Hispanic patients received adequate lymph node evaluation (P ≤ .001), whereas they were associated with receiving no adjuvant multimodality therapy (P ≤ .025).CONCLUSIONS:There were significant variations in treatment for gastric cancer among ethnic groups in the United States. It was noteworthy that, although nonwhite race was associated with improved surgical care, gastric cancer care remained suboptimal overall. Cancer programs need to identify procedures to maximize the delivery of adequate gastric cancer care to all patients. Cancer 2010. © 2010 American Cancer Society.

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The impact of ethnicity on the presentation and prognosis of patients with gastric adenocarcinoma

Cited by 74 publications

References 32 publications

Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: a meta-analysis and meta-regression

Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: a meta-analysis and meta-regression

Demographic Disparities in Patterns of Care and Survival Outcomes for Patients with Resected Gastric Adenocarcinoma

Variations in gastric cancer care

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