Asian patients with gastric carcinoma in the United States exhibit unique clinical features and superior overall and cancer specific survival rates

BACKGROUND. The 5-year survival rate from gastric carcinoma, stratified by stage, is markedly greater in the Far East than in the United States. This survival rate advantage may reflect differences in diagnostic criteria, more complete staging, more radical surgery, or less aggressive tumor biology. METHODS. A historic cohort of consecutive cases of gastric carcinoma reported to the population-based California Cancer Registries of Orange, San Diego and Imperial Counties from 1984 to 1996 was studied. Factors associated with Asian race were profiled using logistic regression. Multivariate survival analyses were performed using a Cox proportional hazard model. RESULTS. Two thousand four hundred sixteen patients (64%) were non-Latino white; 690 (18%) were Latino; 94 (2.5%) were black; 541 (14%) were of Asian descent: Korean (22%), Vietnamese (20%), Japanese (20%), Chinese (14%), and Filipino (12%). Asian patients were more likely to have localized (lymph node negative) disease (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.23-2.10), less likely to have tumors of the gastroesophageal junction (OR, 0.22; 95% CI, 0.15-0.31,), and less likely to be older than 50 years (OR, 0.58; 95% CI, 0.43-0.77). Asian patients with gastric carcinoma were twice as likely as non-Latino whites to be alive at 5 years (20.9% vs. 10.2%; P < 0.0001]. Multivariate analyses indicated that whites had an increased risk of dying from all causes (relative risk [RR], 1.34; 95% CI, 1.16-1.55; P < 0.01] and of dying from cancer in comparison to Asian patients (RR, 1.26; 95% CI, 1.07-1.48; P < 0.05). CONCLUSIONS. Asians who received a diagnosis of gastric carcinoma in the United States have less advanced disease than non-Asians. The increased proportion of localized disease and improved survival rates of patients of Asian descent in the United States is consistent with less aggressive tumor biology. (C) 2000 American Cancer Society.