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Journal of Gastrointestinal Surgery

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01-03-2013 | Original Article

Race and Correlations Between Lymph Node Number and Survival for Patients with Gastric Cancer

Authors: Rebecca Nelson, Eun Bi Ko, Amanda Arrington, Wendy Lee, Jae Kim, Julio Garcia-Aguilar, Joseph Kim

Published in: Journal of Gastrointestinal Surgery | Issue 3/2013

Abstract

Background

There is ongoing debate whether extended lymphadenectomy improves survival in gastric cancer patients who undergo surgical resection. We previously observed that Korean–American patients had the highest overall survival in Los Angeles County. Our objective was to assess lymph node (LN) number and its impact on survival for Korean–American gastric cancer patients.

Methods

We utilized the National Cancer Institute’s Surveillance, Epidemiology, and End Results registry to identify Korean–Americans with gastric adenocarcinoma treated with curative-intent gastrectomy between 1988 and 2008. We grouped patients according to examined LN number (1–15 and 16+) and compared characteristics. We performed similar analysis for white patients.

Results

Out of 982 Korean–American patients with gastric adenocarcinoma, most patients had 1–15 examined LNs (60 %). When we compared LN groups, we observed higher overall survival in the 1–15 group than the 16+ group (5-year survival, 59 % vs 52 %, respectively; p = 0.04). However, LN number was not prognostic of overall survival on stepwise Cox proportional hazards analysis. In contrast, LN number was prognostic for white patients.

Conclusions

Although examined LN number may impact survival for white patients, outcomes of Korean–American gastric cancer patients were independent of LN number. Our data suggest that survival of Korean–American gastric cancer patients are comparable with outcomes from East Asian hospitals and may be independent of surgical technique.

Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol 2006;12:354–362.PubMed

Ohtsu A, Yoshida S, Saijo N. Disparities in gastric cancer chemotherapy between the East and West. J Clin Oncol 2006;24:2188–2196.PubMedCrossRef

Park JM, Kim YH. Current approaches to gastric cancer in Korea. Gastrointest Cancer Res 2008;2:137–144.PubMed

Strong VE, Song KY, Park CH, et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg 2010;251:640–646.PubMedCrossRef

Davis PA, Sano T. The difference in gastric cancer between Japan, USA and Europe: what are the facts? what are the suggestions? Crit Rev Oncol Hematol 2001;40:77–94.PubMedCrossRef

Adachi Y, Kitano S, Sugimachi K. Surgery for gastric cancer: 10-year experience worldwide. Gastric Cancer 2001;4:166–174.PubMedCrossRef

Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H. Surgical treatment for gastric cancer: the Japanese approach. Semin Oncol 1996;23:360–368.PubMed

Wu CW, Hsiung CA, Lo SS, et al. Nodal dissection for patients with gastric cancer: a randomised controlled trial. Lancet Oncol 2006;7:309–315.PubMedCrossRef

Di Leo A, Marrelli D, Roviello F, et al. Lymph node involvement in gastric cancer for different tumor sites and T stage: Italian Research Group for Gastric Cancer (IRGGC) experience. J Gastrointest Surg 2007;11:1146–1153.PubMedCrossRef

10.

Tamura S, Takeno A, Miki H. Lymph node dissection in curative gastrectomy for advanced gastric cancer. International Journal of Surgical Oncology 2011:Article 748745.

11.

Park CH, Song KY, Kim SN. Treatment results for gastric cancer surgery: 12 years’ experience at a single institute in Korea. Eur J Surg Oncol 2008;34:36–41.PubMedCrossRef

12.

Wu CW, Hsiung CA, Lo SS, Hsieh MC, Shia LT, Whang-Peng J. Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg 2004;91:283–287.PubMedCrossRef

13.

Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med 1999;340:908–914.PubMedCrossRef

14.

Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 2004;22:2069–2077.PubMedCrossRef

15.

Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 1999;79:1522–1530.PubMedCrossRef

16.

Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 2010;11:439–449.PubMedCrossRef

17.

Kim J, Sun CL, Mailey B, et al. Race and ethnicity correlate with survival in patients with gastric adenocarcinoma. Ann Oncol 2010;21:152–160.PubMedCrossRef

18.

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;16:2433–2441.PubMedCrossRef

19.

Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001;345:725–730.PubMedCrossRef

20.

van de Velde CJ. Resection for gastric cancer in the community. Semin Oncol 2005;32:S90–S93.PubMedCrossRef

21.

Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007;357:1810–1820.PubMedCrossRef

22.

Lee JH, Ryu KW, Park SR, et al. Learning curve for total gastrectomy with D2 lymph node dissection: cumulative sum analysis for qualified surgery. Ann Surg Oncol 2006;13:1175–1181.PubMedCrossRef

23.

National Cancer Institute. Overview of the SEER Program. 2011. (Accessed January 15, 2012, at http://seer.cancer.gov/about/overview.html.)

24.

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.PubMedCrossRef

25.

Ajani J, Barthel J, Bekaii-Saab T, et al. NCCN Clinical Practice Guidelines in Oncology: Gastric Cancer. J Natl Compr Canc Netw 2010;8:378–409.PubMed

26.

de Aretxabala X, Konishi K, Yonemura Y, et al. Node dissection in gastric cancer. Br J Surg 1987;74:770–773.PubMedCrossRef

27.

Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg 1987;11:418–425.PubMedCrossRef

28.

Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 2004;54:78–93.PubMedCrossRef

29.

Miller B, Kolonel L, Bernstein L, et al. Racial/Ethnic Patterns of Cancer in the United States 1988–1992. Bethesda, MD; 1996.

30.

Morris AM, Rhoads KF, Stain SC, Birkmeyer JD. Understanding racial disparities in cancer treatment and outcomes. J Am Coll Surg 2010;211:105–113.PubMedCrossRef

31.

Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 2008;359:453–462.PubMedCrossRef

32.

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;89:1883–1892.PubMedCrossRef

33.

Ramadori G, Triebel J. Nodal dissection for gastric cancer. N Engl J Med 2008;359:2392; author reply 3.

34.

Stessin AM, Sherr DL. Demographic disparities in patterns of care and survival outcomes for patients with resected gastric adenocarcinoma. Cancer Epidemiol Biomarkers Prev 2011;20:223–233.PubMedCrossRef

35.

Le A, Berger D, Lau M, El-Serag HB. Secular trends in the use, quality, and outcomes of gastrectomy for noncardia gastric cancer in the United States. Ann Surg Oncol 2007;14:2519–2527.PubMedCrossRef

36.

Chen MS, Jr. Cancer health disparities among Asian Americans: what we do and what we need to do. Cancer 2005;104:2895–2902.PubMedCrossRef

37.

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;21:2070–2076.PubMedCrossRef

38.

Lee HJ, Yang HK, Ahn YO. Gastric cancer in Korea. Gastric Cancer 2002;5:177–182.PubMedCrossRef

39.

Kwong SL, Chen MS, Jr., Snipes KP, Bal DG, Wright WE. Asian subgroups and cancer incidence and mortality rates in California. Cancer 2005;104:2975–2981.PubMedCrossRef

Title: Race and Correlations Between Lymph Node Number and Survival for Patients with Gastric Cancer
Authors: Rebecca Nelson
Eun Bi Ko
Amanda Arrington
Wendy Lee
Jae Kim
Julio Garcia-Aguilar
Joseph Kim
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 3/2013
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-2125-x

At a glance: The STEP trials

Springer Medicine

Race and Correlations Between Lymph Node Number and Survival for Patients with Gastric Cancer

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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