1251 Predictors of Stage III/IV Gastric Cancer in the United States

Abstract

INTRODUCTION: The incidence of gastric cancer is declining by 1.5% every year in the United States with an estimated 27,510 new cases and 11,410 deaths in 2019. Five-year relative survival of early gastric cancer (Stage I/II) was 63.2% which declined to 12.3% in advanced stages (Stage III/IV). Most studies have looked at factors associated with overall gastric cancer incidence, but none have compared the factors associated with early and advanced gastric cancer at presentation. We aimed to study the factors that predict advanced cancer stages when compared to early stages. METHODS: The SEER 18 database was queried for gastric cancer cases from 2010 to 2016 when American Joint Committee on Cancer Staging 7th edition was used. Cases were classified into early (Stage I/II) and advanced (Stage III/IV), and multinomial logistic regression was used to predict age, racial/ethnic, gender and tumor characteristics that were more likely with advanced cancer. RESULTS: Analyses demonstrated that males were more likely to have advanced cancer than females (OR 1.216, CI 1.158-1.277). No significant differences were found when comparing Blacks to Whites (1.091, 0.651-1.828) and non-Hispanic Blacks to non-Hispanic Whites (0.963, 0.572-1.622). Spanish Hispanic Latinos were more likely to have advanced cancer than non-Spanish Hispanic Latinos (1.098, 1.028-1.172). Samoans were more likely (2.213, 1.191-4.111) and Koreans were less likely (0.699, 0.553-0.884) to have advanced cancer than whites. Patients in the age groups of 25-29, 30-34 and 35-39 years were more likely to have advanced cancer than those aged ≥50 years (2.657, 1.754-4.025; 1.586, 1.244-2.022 and 1.823, 1.495-2.223 respectively). Tumor sites such as cardia (1.884, 1.718-2.067), fundus (1.428, 1.253-1.627), and body (1.256, 1.129-1.398) were more likely to have advanced cancer when compared to the lesser curvature. CONCLUSION: Certain variables, including age, gender, race/ethnicity and tumor site/grade/histology were more likely to be associated with advanced cancer when compared to early cancer. Younger groups had higher chances of advanced cancer at presentation compared to those aged above 50 years reflecting the probable influences of screening alarm symptoms with endoscopy and the genetic influences of tumor biology. Compared to cancers at the lesser curvature, cancers detected at other sites like cardia, fundus, antrum and pylorus were more likely to be advanced cancers. Studies on larger populations are required to classify and further stratify risk factors.