Initial Presentation of Gastric Cancer Among Various Racial/ethnic Groups at an Academic Center in New York City

Abstract

Introduction: Due to its often asymptomatic presentation or nonspecific manifestations, over one-third of gastric cancers (GC) are diagnosed at an advanced stage with limited, if any, durable treatment options. The initial presentation of gastric cancer among various racial and ethnic minorities in the USA is not well-described. Methods: We performed a retrospective analysis of patients included in a pathology database with histologically confirmed GC between 2008 and 2016 at a single academic center in NYC, who also had confirmatory endoscopic data available. Patients with cancer of the gastroesophageal junction or cardia were excluded. Age at diagnosis, race/ethnicity, smoking status, and presenting signs and/or symptoms were recorded. Statistical analysis was performed in STATA. Results: 108 patients [67.6% men/32.4% women] were included. Median age at diagnosis was 71.5 (range 41-92) years. Racial/ethnic breakdown was as follows: Hispanic/Latino (n=27), Asian (n=19), African-American (AA) (n=18), European/Russian (n=21), non-European/Russian white (n=5), unknown (n=18). Indications for endoscopy were available in 103/108 patients, with only 3 listing “surveillance” as the indication. Abdominal pain/dyspepsia was the most common presenting symptom (n=53), followed by acute GI bleed (n=27), asymptomatic anemia (n=18), weight loss (n=18), and gastric outlet obstruction (n=9), or a combination of these. 29.3% were stage 3 or more advanced at presentation; less than 20%(n=22) had endoscopies prior to GC diagnosis. Asians (61.8+/-1.6 years), AA (70.4+/-2.6 years), Hispanic/Latinos (71.1+/-2.1 years), and Europeans/Russians (72.2+/- 2.4 years) presented at younger ages versus whites (80+/-0.2 years), but the number in the latter group was small (n=5). There was no difference in presenting symptoms between the groups. Although non-whites presented with higher-grade lesions, there was no difference in stage at presentation between the groups (p=0.216). Conclusion: Patients with higher GC risk based on race/ethnicity had similar stage and presenting symptoms compared to whites, with nearly a third of patients having at least stage 3 GC at diagnosis. Only a minority had endoscopies prior to their one at diagnosis. Further research is needed to clarify whether some races/ethnicities may benefit from GC screening.