Tseng Joshua, Miller James P, Johnson Jeffrey, Waters Kevin, Gangi Alexandra, Gong Jun, Burch Miguel
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Gastrointest Oncol. 2021 Aug;12(4):1308-1325. doi: 10.21037/jgo-21-207.
The burden of gastric cancer involving Hispanic patients in the United States is growing as both the population and the incidence of gastric cancer in this group increases. This burden is compounded by presentation with advanced disease and socioeconomic challenges shaping cancer care. We sought to describe the demographics, socioeconomic factors, treatment, and survival experience of Hispanic patients with gastric adenocarcinoma.
Patients with gastric adenocarcinoma diagnosed between 2004 and 2015 (n=90,737) in the National Cancer Database were retrospectively identified. Patients of Hispanic ethnicity were compared against non-Hispanic white patients. Surgical cohort was further analyzed, and 1:1 propensity score matching was used to balance covariates between Hispanic and non-Hispanic white surgical patients. Survival was compared using Kaplan-Meier method. Cox regression was used to determine prognostic factors for survival.
Compared to non-Hispanic white patients, Hispanic patients are more likely to be younger, female, and healthier. They were more likely to be uninsured, reside in poorer neighborhoods and reside in areas with lower rates of education. Hispanic patients were more likely to live in a metropolitan area, travel shorter distances for healthcare, and receive treatment at an academic and high volume centers. Hispanic patients were more likely to have higher stage disease presentation, higher grade tumors, lymphovascular invasion, and poorly cohesive adenocarcinoma. Hispanic patients were more likely to receive surgery, but less likely to receive adjuvant therapy. In Cox regression of all patients, unmatched surgical patients, and matched surgical patients, Hispanic ethnicity was an independent prognostic factor of improved survival.
Hispanic patients with gastric adenocarcinoma present with several unfavorable clinicopathologic and socioeconomic factors. Paradoxically, these patients demonstrate improved survival. Further study is warranted to characterize disease biology in this population.
随着美国西班牙裔人口数量以及该群体中胃癌发病率的上升，西班牙裔胃癌患者的负担日益加重。晚期疾病的表现以及影响癌症治疗的社会经济挑战使这一负担更为复杂。我们试图描述西班牙裔胃腺癌患者的人口统计学特征、社会经济因素、治疗情况及生存经历。
回顾性分析国家癌症数据库中2004年至2015年间诊断为胃腺癌的患者（n = 90,737）。将西班牙裔患者与非西班牙裔白人患者进行比较。对手术队列进行进一步分析，并采用1:1倾向评分匹配法来平衡西班牙裔和非西班牙裔白人手术患者之间的协变量。使用Kaplan-Meier方法比较生存率。采用Cox回归确定生存的预后因素。
与非西班牙裔白人患者相比，西班牙裔患者更可能年轻、为女性且健康状况更好。他们更可能未参保，居住在较贫困社区且所在地区教育水平较低。西班牙裔患者更可能居住在大都市区，就医距离较短，并在学术型和大容量中心接受治疗。西班牙裔患者更可能出现疾病分期较高、肿瘤分级较高、存在淋巴管侵犯以及低黏附性腺癌。西班牙裔患者更可能接受手术，但接受辅助治疗的可能性较小。在对所有患者、未匹配的手术患者以及匹配的手术患者进行的Cox回归分析中，西班牙裔是生存改善的独立预后因素。
西班牙裔胃腺癌患者存在一些不利的临床病理和社会经济因素。矛盾的是，这些患者的生存率有所提高。有必要进一步研究以明确该人群的疾病生物学特征。
