Hispanic Ethnicity Is Associated with Early Presentation and Advanced Stage of Gastric Adenocarcinoma

INTRODUCTION: Gastric adenocarcinoma (GA) is a heterogeneous disease with variable presentation and progression between ethnic groups. We aimed to assess factors related to the early age of GA presentation (< 45 years) between racial and ethnic groups. METHODS: Using the National Cancer Database, patients with GA and upfront surgery were selected. Those receiving neoadjuvant therapy were excluded to ensure accurate pathologic stage. Clinicopathologic data was correlated to factors associated with age at diagnosis. Ethnicity was classified into Non-Hispanic White (NHW), Hispanic (HS), African American (AA) and Asian (AS). Univariate and multivariate linear regression models were used to determine factors associated with age of presentation. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests. RESULTS: Between 2006 and 2013, 13392 patients with GA and upfront surgery were identified. Median age was 67 years (IQR: 57-76) and 61% were male. Mean age at diagnosis was variable between ethnicity (NHW: 7609, 57%, 68 years, HS: 1720, 13%, 61 years, AA: 2727, 20%, 64 years and AS: 1336, 10%, 64 years; p<0.01). HS and AA presented with more advanced stage (Stage 4: HS 20.8%, AA 19.2%, NHW 17.8%, AS 16.2%; p<0.05). On univariate analysis, female gender, HS race, uninsured status, Medicaid, advanced pathologic stage, and poorly differentiated tumor grade were associated with young presentation (p<0.01). On multivariate analysis, factors associated with young presentation included female gender (1.52, 95%CI: 1.31-1.76), minority race compared to NHW (HS: 2.30 95%CI: 1.92-2.86; AA: 1.37 95%CI: 1.24-1.67), and poorly (2.40, 95%CI: 1.34-4.29) or undifferentiated grade (3.56, 95%CI: 1.84-6.99). Median survival was significantly different between races (NHW 23 months, HS 41 months, AA 26 months, AS 50 months, p<0.001). CONCLUSION: Young presentation of GA is associated with HS race, female gender, and advanced tumors. Despite HS presenting at a young age with more advanced disease, median survival was prolonged compared to AA/NHW. Further research is necessary to determine underlying biologic basis of ethnic variation observed in GA.