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Katelin Mirkin*2, Christopher Hollenbeak2, Joyce Wong1
1Lenox Hill Hospital/ Northwell Health, New York, NY; 2Penn State Medical Center, Hershey, PA

Background: Gastric cancer survival in the US differs drastically from that of Asia. Several environmental, genetic, and treatment factors have been implicated. Little is known about the survival of Asian Americans with gastric cancer. This study sought to compare the survival of Asian patients with resectable gastric cancer to non-Asian patients in the US.
Methods: The US National Cancer Database (2003-2011) was reviewed for patients with stage I-III gastric cancer, who underwent neoadjuvant therapy (NAT) or initial surgery, and was stratified by race (White, Black, Asian, Other). Asian was defined as Chinese, Japanese, Filipino, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, and other Asian. Patient demographics, disease, and treatment characteristics were compared between races with ANOVA and chi-square tests. Kaplan Meier and Weibull analyses were performed. Propensity score matching was then used to create comparable Asian and non-Asian cohorts and compare survivor functions.
Results: The study included 9,403 patients: 7,944 White, 780 Black, 399 Asian, and 280 Other. Asian patients were more likely to have a higher income (p<0.001), receive treatment at a community facility (p<0.001) in the West (p<0.001), and have fewer comorbidities (p=0.015). Relative to White, Black, and Other patients, they had earlier clinical stage disease (stage I: 46% vs. 38%, 37%, 38%, respectively, p=0.034), tumors located in the antrum (24% vs 6%, 18%, 15%) or lesser curvature (17% vs 6%, 13%, 11%, p<0.001), and were more likely to undergo a distal gastrectomy (12% vs 8%, 13%, 8%, p<0.001), have a greater number of lymph nodes examined (20 vs 16, 17, 18, p<0.001), and undergo initial surgical resection (88% vs 61%, 80%, 75%, p<0.001). Asian patients who underwent initial surgery demonstrated significantly improved 5Y overall survival (57%) relative to White (42), Black (37%), and Other (52%). There was no significant difference in survival in patients who underwent NAT (p=0.088).
On multivariate analysis, Asian patients had a 28% decreased hazard of mortality relative to White patients (HR 0.72, p<0.001).
After propensity score matching, Asian patients who underwent initial surgery demonstrated improved overall survival as compared to Asians who underwent NAT, Whites who underwent NAT and Whites who underwent initial surgery (p=0.0188).
Conclusion: In the US, Asian race is an independent positive prognostic factor for improved survival in resectable gastric cancer. Asian patients tend to present with earlier clinical stage disease and are more likely to undergo initial surgery than patients of other races. More study is needed to understand the role of NAT in this group of patients.

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