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Upper Gastrointestinal (lips to ileocecal valve, including esophagus and stomach)

E447: Gastric cancer disparities among Asians, Asian Americans, and White Americans: Insights from two leading cancer centers in East and West

    ePoster Abstract Author(s)

  • Ryuhei Aoyama, MD, PhD

    Research fellow
    Department of Surgery, City of Hope National Medical Center, United States

    • Submitter(s)

  • Ryuhei Aoyama, MD, PhD

    Research fellow
    Department of Surgery, City of Hope National Medical Center, United States

    • Author(s)

  • Annie Yang, MBBS (she/her/hers)

    Research Associate
    Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
    Duarte, California, United States

  • Courtney Chen, MD (she/her/hers)

    Resident Physician
    Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
    Los Angeles, California, United States

  • RM

    Rifat Mannan, n/a

    Associate Clinical Professor
    Department of Pathology, City of Hope National Medical Center, United States

  • GI

    Gregory Idos, n/a

    Associate Professor
    Department of Medicine, Division of Gastroenterology, City of Hope National Medical Center, United States

  • DC

    Dani Castillo, n/a

    Assistant Clinical Professor
    Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, United States

  • Laleh Melstrom, MD

    Associate Professor
    Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA
    La Verne, California, United States

  • IP

    Isaac B. Paz, MD

    Clinical Professor
    Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, United States

  • JL

    James Lin, n/a

    Associate Clinical Professor
    Department of Medicine, City of Hope National Medical Center, United States

  • Yumon Fong, MD

    Professor
    Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
    Duarte, CA, California, United States

  • SH

    Shigeo Hisamori, n/a

    Junior Associate Professor
    Department of Surgery, Kyoto University, Japan, United States

  • KO

    Kazutaka Obama, n/a

    Professor
    Department of Surgery, Kyoto University, Japan, United States

  • Yanghee Woo, MD

    Associate Professor
    Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
    Duarte, California, United States

Introduction: Gastric cancer (GC) is a major global cancer burden, with a higher prevalence among Asian populations. Variations in patient demographics, tumor characteristics and management strategies exist across nations.  Nevertheless, the impact of diverse GC treatments on Asian ethnicity remains unclear.

Methods: We performed a retrospective study comparing Japanese GC population treated at Kyoto University, Japan with an ethnically diverse GC population treated at City of Hope, USA. Patients who received gastrectomy for GC (2015-2020) were included. Patient and tumor characteristics, surgical procedures, treatment outcomes, and survival status were compared amongst the following 3 groups; Asian Japanese (JA), Asian Americans (AA), and White Americans (WA) patients. We employed Kruskal-Wallis test for continuous variables, Fisher exact test for categorical variables, long-rank test for survival outcomes, and Bonferroni’s method when providing pairwise comparisons between the 3 groups.

Results: Of a total of 335 patients, the clinicopathologic characteristics, treatments and outcomes for the three cohorts are shown in Table 1.  JA cohort was the oldest with a median age [IQR] of 72 [65-78] years. The median body mass index (kg/mm2) of 25.1 in WA was highest compared to 22.1 (JA) and 23.5 (AA). Consistent with tumor location, the most common extent of resection differed: distal gastrectomy in JA (67.7%) and AA (81.4%) versus total gastrectomy in WA (56.6%). Consistent with advanced GC rates, rate of D2 lymphadenectomy was higher at the U.S. center. However, R0 resection rates did not differ (p = 0.532). Neoadjuvant therapy administration in advanced cases differed between the groups (p < 0.001). Overall postoperative complications were similar; but anastomosis leakage incidence was 9.3% in WA versus 1.3% in JA and 1.7% in AA. In cStage I, the 3-year overall survival (OS) rate was 94.3% in JA, 100% in AA, and 83.3% in WA (p = 0.05); in cStage II 83.7% in JA, 77.9% in AA, and 45.8 in AW (p = 0.06); and in cStage III was 73.5% in JA, 65.3% in AA, and 71.5% in WA (p = 0.90).

Conclusions: AA and JA GC patients share similar patient and tumor characteristics which are distinct from WA patients.  While AA GC patient outcomes mirrored JA, their treatments differed from both JA and WA. Conducting additional studies that examine the real-world impact of these divergent treatment strategies on AA individuals within the ethnically diverse U.S. population may provide valuable insights for optimizing personalized GC treatments.

Learning Objectives:

  • Upon completion, participant will be able to tell the difference of gastric cancer patient demographics and tumor characteristics between Japanese, Asian Americans, and White Americans.
  • Upon completion, participant will be able to tell the difference of gastric cancer treatment between Japanese, Asian Americans, and White Americans.
  • Upon completion, participant will be able to tell the difference of prognosis after gastrectomy for gastric cancer between Japanese, Asian Americans, and White Americans.