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, mor e complete staging, more radical surgery, or less aggressive tumor biology. METHODS. A historic cohort of consecutive cases of gastric carcinoma report ed to the population-based California Cancer Registries of Orange, San Dieg o and Imperial Counties from 1984 to 1996 was studied. Factors associated w ith Asian race were profiled using logistic regression. Multivariate surviv al analyses were performed using a Cox proportional hazard model. RESULTS. Two thousand four hundred sixteen patients (64%) were non-Latino w hite; 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 n ode negative) disease (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.23-2.10), less likely to have tumors of the gastroesophageal junction (O R, 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 twic e 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 ri sk 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 Un ited States have less advanced disease than non-Asians. The increased propo rtion of localized disease and improved survival rates of patients of Asian descent in the United States is consistent with less aggressive tumor biol ogy. (C) 2000 American Cancer Society.