Zhang Gang, Zhao Xing, Li Jie, Yuan Yu, Wen Ming, Hao Xin, Li Ping, Zhang Aimin
Department of Gastrointestinal Surgery, The Affiliated Hospital of Hebei University, Baoding, China.
Department of Pathology, The Affiliated Hospital of Chengde Medical University, Chengde, China.
J Investig Med. 2017 Aug;65(6):991-998. doi: 10.1136/jim-2017-000413. Epub 2017 Apr 25.
The incidence of gastric cancer is declining in western countries but continues to represent a serious health problem worldwide, especially in Asia and among Asian Americans. This study aimed to investigate ethnic disparities in stage-specific gastric cancer, including differences in incidence, treatment and survival. The cohort study was analyzed using the data set of patients with gastric cancer registered in the Surveillance, Epidemiology, and End Results (SEER) program from 2004 to 2013. Among 54,165 patients with gastric cancer, 38,308 were whites (70.7%), 7546 were blacks (13.9%), 494 were American Indian/Alaskan Natives (0.9%) and 7817 were Asians/Pacific Islanders (14.4%). Variables were patient demographics, disease characteristics, surgery/radiation treatment, overall survival (OS) and cause specific survival (CSS). Asians/Pacific Islanders demonstrated the highest incidence rates for gastric cancer compared with other groups and had the greatest decline in incidence during the study period (13.03 to 9.28 per 100,000/year), as well as the highest percentage of patients with American Joint Committee on Cancer (AJCC) early stage gastric cancer. There were significant differences between groups in treatment across stages I-IV (all p<0.001); Asians/Pacific Islanders had the highest rate of surgery plus radiation (45.1%). Significant differences were found in OS and CSS between groups (p<0.001); OS was highest among Asians/Pacific Islanders. Multivariate analysis revealed that age, race, grade, stage, location, and second primary cancer were valid prognostic factors for survival. Marked ethnic disparities exist in age-adjusted incidence of primary gastric cancer, with significant differences between races in age, gender, histological type, grade, AJCC stage, location, second cancer, treatment and survival.
在西方国家，胃癌的发病率正在下降，但在全球范围内，尤其是在亚洲及亚裔美国人中，它仍然是一个严重的健康问题。本研究旨在调查特定分期胃癌的种族差异，包括发病率、治疗和生存率的差异。该队列研究使用了2004年至2013年在监测、流行病学和最终结果（SEER）计划中登记的胃癌患者数据集进行分析。在54165例胃癌患者中，38308例为白人（70.7%），7546例为黑人（13.9%），494例为美洲印第安人/阿拉斯加原住民（0.9%），7817例为亚洲人/太平洋岛民（14.4%）。变量包括患者人口统计学特征、疾病特征、手术/放射治疗、总生存期（OS）和特定病因生存期（CSS）。与其他群体相比，亚洲人/太平洋岛民的胃癌发病率最高，且在研究期间发病率下降幅度最大（从每10万人年13.03降至9.28），同时美国癌症联合委员会（AJCC）早期胃癌患者的比例也最高。I-IV期各阶段的治疗在不同群体之间存在显著差异（所有p<0.001）；亚洲人/太平洋岛民接受手术加放疗的比例最高（45.1%）。不同群体之间在OS和CSS方面存在显著差异（p<0.001）；亚洲人/太平洋岛民的OS最高。多变量分析显示，年龄、种族、分级、分期、位置和第二原发性癌症是生存的有效预后因素。原发性胃癌的年龄调整发病率存在明显的种族差异，不同种族在年龄、性别、组织学类型、分级、AJCC分期、位置、第二癌症、治疗和生存方面存在显著差异。
