FACTORS CANNOT EXPLAIN SUPERIOR JAPANESE OUTCOMES IN STOMACH-CANCER

Objective: To compare the stage-stratified survival of Japanese patien ts treated in Honolulu according to Western techniques with that of Ja panese patients treated in Tokyo according to Japanese techniques, thu s eliminating race as a potentially confounding variable. Design and P atients: Of 312 Honolulu Japanese patients surviving Western-type gast ric resection for neoplasm between 1974 and 1985, 279 were identified with invasive gastric adenocarcinoma unassociated with any second mali gnancy. This Honolulu cohort, treated by Western methods, was retrospe ctively compared with a similar, previously described cohort of 3176 T okyo Japanese patients treated according to Japanese methods. Main Out come Measures: American Joint Committee on Cancer/Union Internationale Contre le Cancer criteria for stage-stratified survival. Results: Des pite non-TNM prognostic factors favoring higher survival for the Honol ulu Japanese patients, for every TNM stage, we observed higher surviva l for the Tokyo Japanese patients who were treated according to Japane se techniques. For stage I disease, the survival rates were 86% vs 96% , respectively (P<.001); for stage II, 69% vs 77% (P=.15), for stage I II, 21% vs 49% (P<.001); and for stage IV, 4% vs 14 % (P<.001). Conclu sions: Because all patients in this study are Japanese, race-related f actors or the ''different-disease'' hypothesis cannot explain these re sults. Lymphadenectomy-related stage-migration and/or differing therap eutic efficacy seem more likely explanations.