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- Title
Survival Outcomes and Patterns of Care for Stage II or III Resected Gastric Cancer by Race and Ethnicity.
- Authors
Wu, S. Peter; Keshavjee, Sara H.; Yoon, Sam S.; Kwon, Steve
- Abstract
Key Points: Question: Among patients with stage II or III gastric cancer who underwent a curative surgical procedure, are there outcome differences by race and ethnicity? Findings: In this cohort study of 6938 patients with clinical stage II or III noncardia gastric adenocarcinoma, Asian and Hispanic patients had statistically significantly better overall survival (OS) compared with White patients. Black patients were observed to have similar OS with White patients overall, but Black patients did have statistically significantly better OS among those who received neoadjuvant therapy. Meaning: Among patients with stage II or III gastric adenocarcinoma undergoing a curative surgical procedure, there were variations in OS associated with race and ethnicity. This cohort study evaluates the differences in outcomes by race and ethnicity of patients with noncardia gastric cancer undergoing surgical procedures with and without neoadjuvant therapy. Importance: Many multimodality treatment regimens exist for gastric adenocarcinoma, including neoadjuvant vs adjuvant chemotherapy, radiation, or both. Neoadjuvant therapy is recommended in the United States for patients with locally advanced gastric cancer; however, it is unknown whether the outcomes of neoadjuvant therapy are associated with race and ethnicity. Objective: To evaluate the differences in outcomes by race and ethnicity of patients with noncardia gastric cancer undergoing surgical procedures with and without neoadjuvant therapy. Design, Setting, and Participants: This retrospective cohort study examined the National Cancer Database from the American College of Surgeons for patients with clinical stage II or III gastric adenocarcinoma, excluding gastric cardia tumors, undergoing surgical resection procedures from January 2006 to December 2019. Statistical analysis was performed from December 2021 to May 2023. Exposure: Patients were stratified by race and ethnicity, and their outcomes were analyzed for those who received and did not receive neoadjuvant therapy. Main Outcomes and Measures: The Cox proportional hazard model was used to compare overall survival (OS) between racial and ethnic groups (Asian, Black, Hispanic, and White) overall and according to receipt of neoadjuvant therapy. Among those who received neoadjuvant therapy, proportional differences in pathological responses were calculated in each group. Results: Among a total of 6938 patients in the cohort, 4266 (61.4%) were male; mean (SD) age was 65.9 (12.8) years; 1046 (15.8%) were Asian, 1606 (24.3%) were Black, 1175 (17.8%) were Hispanic, and 3540 (53.6%) were White. Compared with other races and ethnicities, the group of White patients had significantly more who were 65 years or older with more comorbidities. White patients underwent surgical resection procedures alone without neoadjuvant or adjuvant therapy more frequently than other races and ethnicities. Asian and Black patients had the highest proportion of being downstaged or achieving pathological complete response after neoadjuvant therapy. In multivariate models, perioperative chemotherapy was associated with improved OS (HR, 0.79 [95% CI, 0.69-0.90]), whereas number of positive lymph nodes and surgical margins were associated with the largest decreases in OS. Asian and Hispanic race and ethnicity were associated with significantly improved OS compared with Black and White races (eg, Asian patients: HR, 0.64 [95% CI, 0.58-0.72]; and Hispanic patients: HR, 0.77 [95% CI, 0.69-0.85]). Black race was associated with improved OS compared with White race when receiving neoadjuvant therapy (HR, 0.78 [95% CI, 0.67-0.90]). Conclusions and Relevance: In this large nationwide cohort study of survival outcomes among patients with resected clinical stage II or III gastric cancer, there were significant differences in response to treatment and OS between different racial and ethnic groups.
- Subjects
UNITED States; PUERTO Rico; STOMACH tumors; ADENOCARCINOMA; REPORTING of diseases; STATISTICS; ACADEMIC medical centers; RACE; HEALTH outcome assessment; ACQUISITION of data; RETROSPECTIVE studies; MEDICAL records; DATA analysis software; LONGITUDINAL method; PROPORTIONAL hazards models; OVERALL survival
- Publication
JAMA Network Open, 2023, Vol 6, Issue 12, pe2349026
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.49026