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The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation.

ABSTRACT: Gastric cancer is a heterogeneous disease with variable presentation between racial and ethnic groups. Staging laparoscopy (SL) detects occult metastases not visible on cross-sectional imaging and therefore improves staging. It remains unclear how differences in race and ethnicity affect disease presentation and the yield of SL.We performed a retrospective review of a prospectively maintained database to identify patients with gastric cancer treated with curative intent at our institutions from 2008 to 2015.Hispanic patients presented at an earlier mean age (55.5 ± 11.9 years) compared with Asian (59.8 ± 13.9 years), African American (61.0 ± 10.0 years), and white patients (61.7 ± 12.5 years; p = 0.046) and with more locally advanced disease (clinical stage T3/T4 or node positive; Hispanic 87%; African American 79%; white 68%, Asian 55%; p = 0.03). SL identified 42 patients (34%) with occult metastatic disease. Hispanics were more likely to have a positive SL (44%) than white patients (21%; p = 0.04). On univariate analysis, Hispanic ethnicity, clinical T3/T4, positive nodal disease, signet ring cells, and poor differentiation were predictors of a positive SL. On multivariable analysis, clinical T3/T4, signet ring cells, and poor differentiation independently predicted radiographically occult disease.Hispanic patients presented with more locally advanced disease and were more likely to have occult disease found on SL compared with white patients. Laparoscopy should be used routinely as part of the pretreatment staging evaluation for patients with locally advanced disease as it alters the management in a significant proportion of patients.

SUBMITTER: Nassour I

PROVIDER: S-EPMC5608608 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation.

Nassour Ibrahim I Fullington Hannah H Hynan Linda S LS Yopp Adam C AC Augustine Mathew M MM Polanco Patricio M PM Choti Michael A MA Mansour John C JC Wang Sam C SC Porembka Matthew R MR

Annals of surgical oncology 20170213 7

<h4>Background</h4>Gastric cancer is a heterogeneous disease with variable presentation between racial and ethnic groups. Staging laparoscopy (SL) detects occult metastases not visible on cross-sectional imaging and therefore improves staging. It remains unclear how differences in race and ethnicity affect disease presentation and the yield of SL.<h4>Methods</h4>We performed a retrospective review of a prospectively maintained database to identify patients with gastric cancer treated with curati ...[more]

PMID: 28194592

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Project description:BackgroundDespite guidelines recommending diagnostic laparoscopy in patients with gastric cancer, implementation is low. We aimed to explore trends in the use of laparoscopy for staging of gastric cancer in Alberta, Canada, determine the rate of positive findings and identify factors predictive of positive staging laparoscopy (SL) findings in this patient population.MethodsIn August 2018, we sent a survey to all general surgeons in Alberta who were members of the Alberta Association of General Surgeons to identify those treating gastric cancer. The survey inquired about type of practice (academic or community), gastric cancer case volume, routine versus selective use of SL and, if selective use of SL, criteria used to select cases. Participants were also asked to provide data from their SL cases from July 2007 to February 2019. We double-checked surgeon records with chart review. The primary outcome was evidence of metastatic disease on SL or cytologic examination or both. We performed logistic regression analysis to identify factors predictive of positive laparoscopy findings.ResultsThe survey was completed by 41 of 127 surgeons (response rate 32.3%). We reviewed 116 cases from 5 surgeons at 4 centres. Gross metastatic disease or positive findings on cytologic examination or both were identified in 37 patients (31.9%). On univariate analysis, the following were associated with an increased risk of identification of metastatic disease at laparoscopy: visualization of the primary tumour on computed tomography (CT) (odds ratio [OR] 9.8, 95% confidence interval [CI] 1.2-76.5), presence of abdominal lymphadenopathy greater than 1 cm (OR 2.4, 95% CI 1.1-5.4) and presence of ascites (OR 19.1, 95% CI 2.2-161.8). Visualization of the primary tumour on CT (OR 8.4, 95% CI 1.0-68.3) and the presence of ascites (OR 15.9, 95% CI 1.8-137.0) remained statistically significant predictors on multivariate analysis.ConclusionMetastatic disease was identified at SL in almost one-third of cases, which suggests that SL should still be used routinely in gastric cancer staging in Canadian centres. Our study identified several preoperative imaging findings associated with evidence of metastatic disease on laparoscopy; however, further studies are needed to establish robust predictors of positive findings before advocating for a selective SL approach.

Project description:BACKGROUND & AIMS:Racial and ethnic minorities are reported to have higher mortality related to hepatocellular carcinoma (HCC) than non-Hispanic whites. However, it is not clear whether differences in tumor characteristics or liver dysfunction among racial or ethnic groups affect characterization of causes for this disparity. We aimed to characterize racial and ethnic differences in HCC presentation, treatment, and survival. METHODS:We performed a retrospective study of patients diagnosed with HCC from January 2008 through July 2017 at 2 large health systems in the United States. We used multivariable logistic regression and Cox proportional hazard models to identify factors associated with receipt of curative therapy and overall survival. RESULTS:Among 1117 patients with HCC (35.9% white, 34.3% black, 29.7% Hispanic), 463 (41.5%) were diagnosed with early stage HCC (Barcelona Clinic Liver Cancer stage 0/A) and 322 (28.8%) underwent curative treatment. Hispanic (odds ratio [OR], 0.75; 95% CI, 0.55-1.00) and black patients (OR, 0.74; 95% CI, 0.56-0.98) were less likely to be diagnosed with early stage HCC than white patients. Among patients with early stage HCC, Hispanics were less likely to undergo curative treatment than whites (OR, 0.58; 95% CI, 0.36-0.91). Black patients with early stage HCC were also less likely to undergo curative treatment than white patients, but this difference was not statistically significant (OR, 0.66; 95% CI, 0.43-1.03). Black and Hispanic patients had shorter median survival times than white patients (10.6 and 14.4 mo vs 16.3 mo). After adjusting for type of medical insurance, Child-Pugh class, Barcelona Clinic Liver Cancer stage, and receipt of HCC treatment, black patients had significantly higher mortality (hazard ratio, 1.12; 95% CI, 1.10-1.14) and Hispanic patients had lower mortality (hazard ratio, 0.83; 95% CI, 0.74-0.94) than white patients. CONCLUSIONS:In a retrospective study of patients diagnosed with HCC, we found racial/ethnic differences in outcomes of HCC to be associated with differences in detection of tumors at early stages and receipt of curative treatment. These factors are intervention targets for improving patient outcomes and reducing disparities.

Project description:Background: The COVID-19 pandemic has exposed longstanding racial/ethnic inequities in health risks and outcomes in the U.S.. We sought to identify racial/ethnic differences in presentation and outcomes for patients hospitalized with COVID-19. Methods: The American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7,868 patients by race/ethnicity treated at 88 hospitals across the US between 01/17/2020 and 7/22/2020. The primary outcome was in-hospital mortality; secondary outcomes included major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization without any of the above). Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital. Results: Among 7,868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios (ORs) for mortality were 0.93 (95% confidence interval [CI] 0.76-1.14) for Black patients, 0.90 (95% CI 0.73-1.11) for Hispanic patients, and 1.31 (95% CI 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median OR across hospitals was 1.99 (95% CI 1.74-2.48). Results were similar for MACE. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted OR 1.48, 95% CI 1.16-1.90). Conclusions: Although in-hospital mortality and MACE did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity due to their disproportionate representation among COVID-19 hospitalizations.

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The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation.

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The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation.

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