One Size Does Not Fit All: Marked Heterogeneity in Incidence of and Survival from Gastric Cancer among Asian American Subgroups
One Size Does Not Fit All: Marked Heterogeneity in Incidence of and Survival from Gastric Cancer among Asian American Subgroups
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DOI：
10.1158/1055-9965.epi-19-1482
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发表时间：
2020-05-01
影响因子：
3.8
通讯作者：
Palaniappan, Latha P.
中科院分区：
文献类型：
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作者：
Huang, Robert J.;Sharp, Nora;Palaniappan, Latha P.
背景：相对于非西班牙裔白人（NHW），亚裔美国人患非贲门部胃癌（NCGC）的风险更高。亚裔美国人在基因、语言和文化上都是异质的，但在以前的研究中大多被视为一个单一的群体。这种聚集可能会掩盖重要的亚组特异性癌症patterns.Methods：我们利用1990年至2014年美国13个地区癌症登记处的数据，以确定NCGC的发病率和生存率的长期趋势。数据进行了分析NHWs和六个最大的亚裔美国人亚组：中国，日本，菲律宾，韩国，越南和南亚（印度/巴基斯坦）。结果：存在很大的异质性NCGC的发病率之间的亚洲亚组，韩国人（48.6每100,000人年）有7倍的年龄调整的发病率比南亚人（7.4每100,000人年）。与NHWs相比，亚洲人的诊断阶段通常较早，手术切除率较高。所有亚洲亚组的5年观察生存率均高于NHWs，韩国人（41.3%）和南亚人（42.8%）的生存率是NHWs（20.1%，P < 0.001）的两倍。在多变量回归分析中，诊断阶段和切除率的差异部分解释了亚洲subgroup.Conclusions之间生存率的差异：我们发现亚洲亚组之间NCGC的发病率，分期，组织学，治疗和生存率有很大差异，这些数据挑战了我们对亚洲人胃癌的传统观念。生物异质性和文化/环境差异可能是这些findings.Impact的基础：这些数据是相关的国家话语胃癌筛查的适当作用，并确定高风险的种族/民族亚组谁受益于定制的风险衰减程序。
Background: Asian Americans are at higher risk for noncardia gastric cancers (NCGC) relative to non-Hispanic Whites (NHW). Asian Americans are genetically, linguistically, and culturally heterogeneous, yet have mostly been treated as a single population in prior studies. This aggregation may obscure important subgroup-specific cancer patterns.Methods: We utilized data from 13 regional United States cancer registries from 1990 to 2014 to determine secular trends in incidence and survivorship from NCGC. Data were analyzed for NHWs and the six largest Asian American subgroups: Chinese, Japanese, Filipino, Korean, Vietnamese, and South Asian (Indian/Pakistani).Results: There exists substantial heterogeneity in NCGC incidence between Asian subgroups, with Koreans (48.6 per 100,000 person-years) having seven-fold higher age-adjusted incidence than South Asians (7.4 per 100,000 person-years). Asians had generally earlier stages of diagnosis and higher rates of surgical resection compared with NHWs. All Asian subgroups also demonstrated higher 5-year observed survival compared with NHWs, with Koreans (41.3%) and South Asians (42.8%) having survival double that of NHWs (20.1%, P < 0.001). In multivariable regression, differences in stage of diagnosis and rates of resection partially explained the difference in survivorship between Asian subgroups.Conclusions: We find substantial differences in incidence, staging, histology, treatment, and survivorship from NCGC between Asian subgroups, data which challenge our traditional perceptions about gastric cancer in Asians. Both biological heterogeneity and cultural/environmental differences may underlie these findings.Impact: These data are relevant to the national discourse regarding the appropriate role of gastric cancer screening, and identifies high-risk racial/ethnic subgroups who many benefit from customized risk attenuation programs.