Racial factors cannot explain superior Japanese outcomes in stomach cancer
S. A. Hundahl, G. N. Stemmermann and A. Oishi
Queen's Medical Center, Cancer Research Center of Hawaii, Honolulu, USA.
OBJECTIVE: To compare the stage-stratified survival of Japanese patients
treated in Honolulu according to Western techniques with that of Japanese
patients treated in Tokyo according to Japanese techniques, thus
eliminating race as a potentially confounding variable. DESIGN AND
PATIENTS: Of 312 Honolulu Japanese patients surviving Western-type gastric
resection for neoplasm between 1974 and 1985, 279 were identified with
invasive gastric adenocarcinoma unassociated with any second malignancy.
This Honolulu cohort, treated by Western methods, was retrospectively
compared with a similar, previously described cohort of 3176 Tokyo Japanese
patients treated according to Japanese methods. MAIN OUTCOME MEASURES:
American Joint Committee on Cancer/Union Internationale Contre le Cancer
criteria for stage-stratified survival. RESULTS: Despite non-TNM prognostic
factors favoring higher survival for the Honolulu Japanese patients, for
every TNM stage, we observed higher survival for the Tokyo Japanese
patients who were treated according to Japanese techniques. For stage I
disease, the survival rates were 86% vs 96%, respectively (P < .001);
for state II, 69% vas 77% (P = .15); for stage III, 21% vs 49% (P <
.001); and for stage IV, 4% vs 14% (P < .001). CONCLUSIONS: Because all
patients in this study are Japanese, race-related factors or the
"different-disease" hypothesis cannot explain these results.
Lymphadenectomy-related stage-migration and/or differing therapeutic
efficacy seem more likely explanations.
