Journal of Clinical Oncology, Vol 21, Issue 22
(November), 2003: 4253
© 2003 American Society for Clinical Oncology
Ethnicity-Related Gastric Cancer Survival
Charles P. Theuer
Departments of Surgery and Medicine, University of California, Irvine, CA
To the Editor: Gill et al1 examined 2,043 cases of gastric cancer treated at a Canadian institution, and reported that Asian subjects, largely of Chinese descent, exhibited a hazard ratio lower than that of non-Asian subjects (0.89), but that this difference was not statistically significant. They also detected a greater benefit from curative surgery in Asians as compared with non-Asians.
They concluded that, while their study may have been underpowered, ". . . even if we assume the lower limit of [the calculated 95%] CI to be the true effect, a 26% proportional reduction in mortality would only improve a 5-year survival estimate of 12% to 20% . . .," which is ". . . insufficient to account for the great disparity with Asian survival rates, which remain three-fold higher than North American rates." Our prior study of 3,770 Southern Californian gastric cancer subjects had sufficient power to detect a 34% increased risk of dying among non-Asian subjects compared with Asian subjects of primarily of Japanese, Korean, and Vietnamese descent. This result is likewise insufficient to explain the great disparity between Japanese and US gastric cancer survival.2 Given the complexity of comparisons of Eastern and Western gastric cancer survival, however, it should come as little surprise that one explanation is insufficient to resolve the current conundrum.
It is clear that other issues bias in favor of improved Asian gastric cancer survival. For example, Japanese patients are more likely to be diagnosed with node-negative gastric cancer that can be cured with surgical resection.3 Furthermore, studies comparing survival rates in gastric cancer subjects in the East and West are compromised by variability in diagnostic criteria for malignancy, because in Japan, gastric cancer is diagnosed on nuclear and structural criteria even when invasion is absent according to the Western viewpoint.4 The tendency of Japanese pathologists to diagnose malignancy without evidence of invasion will increase Japanese gastric cancer cure rates. Also, studies comparing survival rates in patients from the East and West also are compromised by variability in surgical treatment,3 with US patients being much less likely to undergo a D2-level dissection. The tendency of US subjects to have limited lymph nodes examined for malignancy produces stage migration (the Will Rogers effect) and may affect cure rates, both of which will decrease stage-stratified gastric cancer survival in the United States.
Thus, while we agree with Gill et al that results from their study are insufficient to explain the entire disparity between Eastern and Western gastric cancer survival, it is important to realize that this conclusion should not be misinterpreted to imply that differences in tumor biology do not contribute to the disparate gastric cancer outcomes between the two regions.
AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST
The following author or their immediate family members have indicated a financial interest. No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation. Owns stock (not including shares held through a public mutual fund): Charles P. Theuer, IDEC Pharmaceuticals. Acted as a consultant within the last 2 years: Charles P. Theuer, IDEC Pharmaceuticals. Performed contract work within the last 2 years: Charles P. Theuer, IDEC Pharmaceuticals. Served as an officer or member of the Board of a company: Charles P. Theuer, IDEC Pharmaceuticals. Received more than $2,000 a year from a company for either of the last 2 years: Charles P. Theuer, IDEC Pharmaceuticals.
REFERENCES
1. Gill S, Shah A, Le N, et al: Asian ethnicity-related differences in gastric cancer presentation and outcome among patients treated at a Canadian cancer center. J Clin Oncol 21:2070–2076, 2003[Abstract/Free Full Text]
2. Theuer CP, Kurosaki T, Ziogas A, et al: Asian patients with gastric carcinoma in the United States exhibit unique clinical features and superior overall and cancer specific survival rates. Cancer 89:1883–1892, 2000[CrossRef][Medline]
3. Brennan MF, Karpeh MS: Surgery for gastric cancer: The American view. Semin Oncol 23:352–359, 1996[Medline]
4. Schlemper RJ, Itabashi M, Kato Y, et al: Differences in diagnostic criteria for gastric carcinoma between Japanese and Western pathologists. Lancet 349:1725–1729, 1997[CrossRef][Medline]
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Facebook  Reddit  Technorati  Twitter What's this?
Related Article
This article has been cited by other articles:
|
|
|
|
 
S. N. Gebara and H. Moubayed
Risk of osteonecrosis of the jaw in cancer patients taking bisphosphonates
Am. J. Health Syst. Pharm.,
September 1, 2009;
66(17):
1541 - 1547.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Edwards and C. A. Migliorati
Osteoporosis and Its Implications for Dental Patients
J Am Dent Assoc,
May 1, 2008;
139(5):
545 - 552.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Garcia-Ferrer, J. V. Bagan, V. Martinez-Sanjuan, S. Hernandez-Bazan, R. Garcia, Y. Jimenez-Soriano, and V. Hervas
MRI of Mandibular Osteonecrosis Secondary to Bisphosphonates
Am. J. Roentgenol.,
April 1, 2008;
190(4):
949 - 955.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. T. Grbic, R. Landesberg, S.-Q. Lin, P. Mesenbrink, I. R. Reid, P.-C. Leung, N. Casas, C. P. Recknor, Y. Hua, P. D. Delmas, et al.
Incidence of Osteonecrosis of the Jaw in Women With Postmenopausal Osteoporosis in the Health Outcomes and Reduced Incidence With Zoledronic Acid Once Yearly Pivotal Fracture Trial
J Am Dent Assoc,
January 1, 2008;
139(1):
32 - 40.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Siegel, C. A. Migliorati, I. Velez, and M. Forrest
Exposed bone in the palate
J Am Dent Assoc,
October 1, 2007;
138(10):
1341 - 1343.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. C. Adornato, I. Morcos, and J. Rozanski
The treatment of bisphosphonate-associated osteonecrosis of the jaws with bone resection and autologous platelet-derived growth factors
J Am Dent Assoc,
July 1, 2007;
138(7):
971 - 977.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. D Krueger, P. M West, M. Sargent, A. E Lodolce, and A S. Pickard
Bisphosphonate-Induced Osteonecrosis of the Jaw
Ann. Pharmacother.,
February 1, 2007;
41(2):
276 - 284.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G Sanna, L Preda, R Bruschini, M Cossu Rocca, S Ferretti, L Adamoli, E Verri, L Franceschelli, A Goldhirsch, and F Nole
Bisphosphonates and jaw osteonecrosis in patients with advanced breast cancer
Ann. Onc.,
October 1, 2006;
17(10):
1512 - 1516.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
American Dental Association Council on Scientific
Dental management of patients receiving oral bisphosphonate therapy: Expert panel recommendations.
J Am Dent Assoc,
August 1, 2006;
137(8):
1144 - 1150.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Van den Wyngaert, M. T. Huizing, and J. B. Vermorken
Bisphosphonates and osteonecrosis of the jaw: cause and effect or a post hoc fallacy?
Ann. Onc.,
August 1, 2006;
17(8):
1197 - 1204.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Tanvetyanon and P. J. Stiff
Management of the adverse effects associated with intravenous bisphosphonates
Ann. Onc.,
June 1, 2006;
17(6):
897 - 907.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. D. Mignogna, L. Lo Russo, S. Fedele, R. Ciccarelli, and L. Lo Muzio
CASE 2. Osteonecrosis of the Jaws Associated With Bisphosphonate Therapy
J. Clin. Oncol.,
March 20, 2006;
24(9):
1475 - 1477.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Badros, D. Weikel, A. Salama, O. Goloubeva, A. Schneider, A. Rapoport, R. Fenton, N. Gahres, E. Sausville, R. Ord, et al.
Osteonecrosis of the Jaw in Multiple Myeloma Patients: Clinical Features and Risk Factors
J. Clin. Oncol.,
February 20, 2006;
24(6):
945 - 952.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Ruggiero, J. Gralow, R. E. Marx, A. O. Hoff, M. M. Schubert, J. M. Huryn, B. Toth, K. Damato, and V. Valero
Practical Guidelines for the Prevention, Diagnosis, and Treatment of Osteonecrosis of the Jaw in Patients With Cancer
J. Oncol. Pract,
January 1, 2006;
2(1):
7 - 14.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. MIGLIORATI, J. CASIGLIA, J. EPSTEIN, P. L. JACOBSEN, M. A. SIEGEL, and S.-B. WOO
Managing the care of patients with bisphosphonate-associated osteonecrosis: An American Academy of Oral Medicine position paper
J Am Dent Assoc,
December 1, 2005;
136(12):
1658 - 1668.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. MARKIEWICZ, J. E. MARGARONE III, J. H. CAMPBELL, and A. AGUIRRE
Bisphosphonate-associated osteonecrosis of the jaws: A review of current knowledge
J Am Dent Assoc,
December 1, 2005;
136(12):
1669 - 1674.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
