Skip to main content
Top
Published in: Journal of Gastrointestinal Surgery 10/2014

01-10-2014 | Original Article

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

Authors: Shinichi Fukuhara, Mariko Yabe, Marissa M. Montgomery, Shinobu Itagaki, Steven T. Brower, Martin S. Karpeh Jr

Published in: Journal of Gastrointestinal Surgery | Issue 10/2014

Login to get access

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.
Literature
3.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
4.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
5.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
6.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
7.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
8.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
9.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
10.
go back to reference Fukami N. ESD Around the World: United States. Gastrointest Endosc Clin N Am. 2014;24:313–320.PubMedCrossRef Fukami N. ESD Around the World: United States. Gastrointest Endosc Clin N Am. 2014;24:313–320.PubMedCrossRef
11.
go back to reference American Joint Committee on Cancer. Cancer staging manual. 7th ed. Chicago: Springer; 2010.CrossRef American Joint Committee on Cancer. Cancer staging manual. 7th ed. Chicago: Springer; 2010.CrossRef
12.
go back to reference 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.PubMedCrossRefPubMedCentral 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.PubMedCrossRefPubMedCentral
13.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
14.
go back to reference 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.PubMedCrossRefPubMedCentral 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.PubMedCrossRefPubMedCentral
15.
go back to reference 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 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
16.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
17.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
18.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
19.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
20.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
21.
go back to reference 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 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
22.
go back to reference Kodera Y. Surgery for gastric cancer: Has the East versus West issue been solved? Dig Surg. 2013;30:92–5.PubMedCrossRef Kodera Y. Surgery for gastric cancer: Has the East versus West issue been solved? Dig Surg. 2013;30:92–5.PubMedCrossRef
23.
go back to reference Hochwald SN, Brennan MF, Klimstra DS, Kim S, Karpeh MS. Is lymphadenectomy necessary for early gastric cancer? Ann Surg Oncol. 1999;6:664–70.PubMedCrossRef Hochwald SN, Brennan MF, Klimstra DS, Kim S, Karpeh MS. Is lymphadenectomy necessary for early gastric cancer? Ann Surg Oncol. 1999;6:664–70.PubMedCrossRef
24.
go back to reference Seto Y, Nagawa H, Muto T. Impact of lymph node metastasis on survival with early gastric cancer. World J Surg. 1997;21:186–9.PubMedCrossRef Seto Y, Nagawa H, Muto T. Impact of lymph node metastasis on survival with early gastric cancer. World J Surg. 1997;21:186–9.PubMedCrossRef
25.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
26.
go back to reference Smith BR, Stabile BE. Extreme aggressiveness and lethality of gastric adenocarcinoma in the very young. Arch Surg. 2009;144:506–10.PubMedCrossRef Smith BR, Stabile BE. Extreme aggressiveness and lethality of gastric adenocarcinoma in the very young. Arch Surg. 2009;144:506–10.PubMedCrossRef
27.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
28.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
29.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
30.
go back to reference Griffin SM. Gastric cancer in the East: same disease, different patient. Br J Surg. 2005;92:1055–6.PubMedCrossRef Griffin SM. Gastric cancer in the East: same disease, different patient. Br J Surg. 2005;92:1055–6.PubMedCrossRef
31.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
32.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
33.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
Metadata
Title
Race/Ethnicity Is Predictive of Lymph Node Status in Patients with Early Gastric Cancer
Authors
Shinichi Fukuhara
Mariko Yabe
Marissa M. Montgomery
Shinobu Itagaki
Steven T. Brower
Martin S. Karpeh Jr
Publication date
01-10-2014
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 10/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-014-2590-5

Other articles of this Issue 10/2014

Journal of Gastrointestinal Surgery 10/2014 Go to the issue