A retrospective study of patients with gastric cancer in the United States showed differences in patient- and disease-related characteristics, as well as different frequencies of staging laparoscopy, treatment/surgical approaches, and specific clinical outcomes, for those of Hispanic compared with non-Hispanic ethnicity. This study was published in the Journal of Surgical Oncology.
In the US, the incidence of gastric cancer is approximately 2-fold higher for individuals of Hispanic ethnicity compared with non-Hispanic Caucasians. Furthermore, gastric cancer is the seventh leading cause of death for Hispanics in the US, and tends to present in this subgroup at more advanced stages and with more aggressive histological features compared with non-Hispanic whites.
“There is a lack of prospective data on treatment and outcomes for Hispanic patients with gastric cancer. Additionally, Hispanic patients were not included in The Cancer Genome Atlas genetic profiling study of gastric cancer, so there is similarly a gap in understanding the underlying disease biology in this clinically distinct population,” the authors wrote.
In this study, a total of 129,666 patients diagnosed with gastric adenocarcinoma between 2004 and 2014 were identified based on their inclusion in the National Cancer Database, a national oncology outcomes database sponsored by the American College of Surgeons and the American Cancer Society. Of these patients, 13,664 (10.5%) were identified as being of Hispanic ethnicity.
Age at disease presentation was younger for the Hispanic subgroup (63 years) compared with the non-Hispanic subgroup (69 years; P <.001). In addition, demographic characteristics that varied between these 2 subgroups included female gender (41% [Hispanic] vs 34.9% [non-Hispanic]; P <.001), and uninsured status (14% vs 3%; P <.001). While there was no significant difference in the percentages of these subgroups likely to present at an academic medical center (37.9% vs 37.8%; P =.904), those of Hispanic ethnicity were more likely to have stage IV disease at presentation (odds ratio=1.33; P <.001).
With respect to surgical staging and treatment approaches, Hispanic patients with stage 0 to stage III disease were more likely to receive curative-intent surgery (63.5% vs 56.9%; P <.001) and undergo staging laparoscopy (5.6% vs 4.9%; P =.0037) compared with non-Hispanic patients. However, Hispanic patients were less likely to undergo an R0 surgical resection (91.2% vs 92.8%; P =.004), to have minimally invasive gastrectomy (25.6% vs 29.1%; P =.004), or to received neoadjuvant therapy for stage II/III disease (31.7% vs 38.7%; P <.001) compared with non-Hispanic patients.
Interestingly, median overall survival for patients with all-stage gastric cancer was significantly higher in the Hispanic subgroup (15.5 months vs 13.2 months; P <.001), and this relative survival benefit was observed when each disease stage was considered separately.
In their concluding comments, the authors wrote that “there is a critical need for prospective, or at least comparative effectiveness, studies of Hispanic patients with gastric cancer to optimize therapies, both in the US and abroad.”
- Zhao B, Leichman LP, Horgan S, Bouvet M, Kelly KJ. Evaluation of treatment and outcomes for Hispanic patients with gastric cancer at Commission on Cancer-accredited centers in the United States [published online February 11, 2019]. J Surg Oncol. doi: 10.1002/jso.25408