Gastric adenocarcinoma burden and late-stage diagnosis in Latino and non-Latino populations in the United States and Texas, during 2004-2016: A multilevel analysis

Clinical Informatics Approaches to Understand and Address Cancer Disparities

OBJECTIVES

Disparities in cancer incidence and outcomes across race, ethnicity, gender, socioeconomic status, and geography are well-documented, but their etiologies are often poorly understood and multifactorial. Clinical informatics can provide tools to better understand and address these disparities by enabling high-throughput analysis of multiple types of data. Here, we review recent efforts in clinical informatics to study and measure disparities in cancer.

METHODS

We carried out a narrative review of clinical informatics studies related to cancer disparities and bias published from 2018-2021, with a focus on domains such as real-world data (RWD) analysis, natural language processing (NLP), radiomics, genomics, proteomics, metabolomics, and metagenomics.

RESULTS

Clinical informatics studies that investigated cancer disparities across race, ethnicity, gender, and age were identified. Most cancer disparities work within clinical informatics used RWD analysis, NLP, radiomics, and genomics. Emerging applications of clinical informatics to understand cancer disparities, including proteomics, metabolomics, and metagenomics, were less well represented in the literature but are promising future research avenues. Algorithmic bias was identified as an important consideration when developing and implementing cancer clinical informatics techniques, and efforts to address this bias were reviewed.

CONCLUSIONS

In recent years, clinical informatics has been used to probe a range of data sources to understand cancer disparities across different populations. As informatics tools become integrated into clinical decision-making, attention will need to be paid to ensure that algorithmic bias does not amplify existing disparities. In our increasingly interconnected medical systems, clinical informatics is poised to untap the full potential of multi-platform health data to address cancer disparities.

Sex and age differences in mortality trends of gastric cancer among Hispanic/Latino populations in the United States, Latin America, and the Caribbean

Background

An up-to-date analysis of gastric cancer mortality among Hispanic/Latino populations is required for estimating disease burden and assessing the effectiveness of clinical and preventive strategies.

Methods

We retrieved gastric cancer deaths between 1997 and 2017 (as available) from the Surveillance, Epidemiology, and End Results Program (United States Hispanics) and the World Health Organization databases (Puerto Rico, 16 Latin American and Caribbean countries). Joinpoint regression analysis was used to examine trends in age-standardized mortality rates (ASMR; per 100 000 person-years) and calculate average annual percent changes (AAPCs) by country (or territory), age group (25-49 and ≥50 years), and sex. Trends were compared to assess slope parallelism.

Findings

In 2017, Chile (31·8), Colombia (24·3) and Costa Rica (24·3) had the highest ASMR of gastric cancer for men, while Guatemala (17·2), Peru (13·5), and Costa Rica (13·3) had the highest ASMR for women. Small-to-moderate mortality declines (AAPCs ranged -4 to -0.5%) were observed between 1997 and 2017. In almost all countries, trends decreased among individuals aged ≥50 years. However, age-specific trends were not parallel (p-values <0.05) in Brazil, Colombia, Mexico, the United States, and Venezuela for both men and women, and in five additional countries for only women; with a few countries showing stable or slightly increasing trends for individuals aged 25-49 years.

Interpretation

Overall gastric cancer mortality rates in Hispanics/Latinos declined in the last two decades. However, there was a notable variation in trends by country, sex, and age group. Continued and targeted prevention efforts are needed to reduce the disease burden in these vulnerable populations.

Funding

Universidad Cientifica del Sur, Peru, and National Cancer Institute, United States.

Nutritional Risk Index as a Prognostic Factor Predicts the Clinical Outcomes in Patients With Stage III Gastric Cancer

Objective

This study is aimed to determine the potential prognostic significance of nutritional risk index (NRI) in patients with stage III gastric cancer.

Methods

A total of 202 patients with stage III gastric cancer were enrolled in this study. NRI was an index based on ideal body weight, present body weight, and serum albumin levels. All patients were divided into two groups by receiver operating characteristic curve: low NRI group (NRI&lt;99) and high NRI group (NRI≥99). The relationship between NRI and clinicopathologic characteristics was evaluated by Chi-square test. The clinical survival outcome was analyzed by Kaplan-Meier method and compared using log-rank test. The univariate and multivariate analyses were used to detect the potential prognostic factors. A nomogram for individualized assessment of disease-free survival (DFS) and overall survival (OS). The calibration curve was used to evaluate the performance of the nomogram for predicted and the actual probability of survival time. The decision curve analysis was performed to assess the clinical utility of the nomogram by quantifying the net benefits at different threshold probabilities.

Results

The results indicated that NRI had prognostic significance by optimal cutoff value of 99. With regard to clinicopathologic characteristics, NRI showed significant relationship with age, weight, body mass index, total protein, albumin, albumin/globulin, prealbumin, glucose, white blood cell, neutrophils, lymphocyte, hemoglobin, red blood cell, hematocrit, total lymph nodes, and human epidermal growth factor receptor 2 (P&lt;0.05). Through the univariate and multivariate analyses, NRI, total lymph nodes, and tumor size were identified as the independent factor to predict the DFS and OS. The nomogram was used to predict the 1-, 3-, and 5-year survival probabilities, and the calibration curve showed that the prediction line matched the reference line well for 1-, 3-, and 5-year DFS and OS. Furthermore, the decision curve analysis also showed that the nomogram model yielded the best net benefit across the range of threshold probability for 1-, 3-, 5-year DFS and OS.

Conclusions

NRI is described as the potential prognostic factor for patients with stage III gastric cancer and is used to predict the survival and prognosis.

Gastric adenocarcinoma burden and late-stage diagnosis in Latino and non-Latino populations in the United States and Texas, during 2004-2016: A multilevel analysis

Background

Gastric cancer disproportionately affects Latinos, but little is known about regional effects and risk factors. We compared primary incidence, late‐stage diagnosis, and risk factors for gastric adenocarcinoma (GCA) from 2004 to 2016 in Latinos and non‐Latinos in the United States, Texas (TX), and South Texas (STX).

Methods

We collected case data from Surveillance, Epidemiology, and End Results (SEER) and the Texas Cancer Registry. We generated average annual age‐adjusted incidence rates, rate ratios (RRs), and 95% confidence intervals (CIs) using SEER*Stat software and analyzed the cases by anatomic site, demographics, and county‐level risk factors using SAS 9.4. We constructed multilevel logistic regression models for late‐stage GCA, adjusting for patient‐ and county‐level characteristics.

Results

Latinos had higher overall GCA incidence rates in all regions, with the greatest disparities in overlap GCA in STX males (RR 4.39; 95% CI: 2.85, 6.93). There were no differences in cardia GCA rates for non‐Hispanic Whites (NHWs) and Latino women in all regions. Younger patients, patients with overlapping or not otherwise specified (NOS) lesions, and patients diagnosed during 2012–2016 had higher odds of late‐stage GCA. The stratification by location showed no differences in late‐stage disease between NHWs and Latinos. The stratification by anatomic site showed Latinos with cardia GCA were more likely to have late‐stage GCA than NHWs (OR: 1.13, p = 0.008). At the county level, higher odds of late‐stage GCA were associated with medium and high social deprivation levels in TX without STX (OR: 1.25 and 1.20, p = 0.007 and 0.028, respectively), and medium social deprivation index (SDI) in patients with NOS GCA (OR: 1.21, p = 0.01).

Conclusions

STX Latinos experience greater GCA disparities than those in TX and the United States. Younger age and social deprivation increase the risk for late‐stage GCA, while Latinos and women are at higher risk specifically for late‐stage cardia GCA. There is a need for population‐specific, culturally responsive intervention and prevention measures, and additional research to elucidate contributing risk factors.

Latinos had higher gastric adenocarcinoma incidence than non‐Latinos in the U.S., Texas and South Texas from 2004 to 2016. Younger age and social deprivation increased risk of late‐stage diagnosis, while Latino ethnicity and female gender increased risk of late‐stage gastric adenocarcinoma of the cardia specifically.