Stage at diagnosis, treatment, and survival among US- and foreign-born Asian and Pacific Islanders with gastric cancer Free

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Background: Asians and Pacific Islanders (APIs) have increased risk of developing gastric cancer, but whether cancer treatments and outcomes vary by birthplace is unknown. We examined the association between birthplace and cancer stage at diagnosis, treatment, and survival comparing API and non-Hispanic white (NHW) patients.
 Methods: We studied 8885 NHW and 5439 API patients diagnosed with gastric cancer from the Surveillance, Epidemiology and End Results Program between 1992 and 2003. We used bivariable analyses to compare stage, receipt of adequate lymph node assessment and surgery across groups: US-born APIs, foreign-born APIs and NHWs. Multivariable polytomous logistic and proportional hazards regression models were used to determine differences between US-born and foreign-born APIs compared to NHWs by cancer stage and survival, respectively.
 Results: As an aggregate group, APIs were more likely than NHWs to present with earlier-stage diagnoses and receive surgery and adequate lymph node assessment (p<0. 001). However, foreign-born [aOR=0.81 (0.74-0.89)] but not US-born APIs [aOR=0.94 (0.825-1.08)] were significantly less likely to present at later stages than NHWs. Although foreign-born and US-born APIs were more likely to receive surgery compared to NHWs, foreign-born [aRR=1.28 (1.17-1.41)] and not US-born APIs [aRR=1.14 (0.98-1.32)] were then more likely to receive adequate lymph node assessment. In fully adjusted models, foreign-born [aHR= 0.85 (0.80-0.90)] but not US-born APIs [(aHR= 0.92 (0.85-1.00)] had more favorable overall survival than NHWs.
 Conclusions: Compared to NHWs, foreign-born but not US-born API patients with gastric cancer present with earlier-staged disease, and are more likely to receive adequate surgical lymph node assessment. Foreign-born API patients further demonstrate significantly better survival than non-Hispanic white patients.