Birthplace and esophageal cancer incidence patterns among Asian-Americans

Shattering the monolith: burden of gastrointestinal cancer in Asian Americans, Native Hawaiians, and Pacific Islanders in the United States

Asian Americans remain the fastest-growing racial group in the United States, and are anticipated to double over the next few decades. Asian Americans are the only major racial-ethnic group for whom cancer remains the leading cause of death, and multiple gastrointestinal cancers rank among the top five incident and fatal cancers. Most research to date presents Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) in aggregate, overlooking their vast heterogeneity and hindering efforts to identify and address health disparities within AANHPI origin groups. Here, we present gastrointestinal cancer incidence and mortality in AANHPI, including disaggregated rates where feasible, and highlight gaps in current screening practices. We conclude with actionable suggestions to shift away from using broad racial categories to evaluate cancer disparities, towards high-quality, disaggregated data to better isolate and address factors driving the clear differential cancer risks among AANHPI.

Asian Americans have higher 30-day surgical complications after esophagectomy: A propensity-score matched study from ACS-NSQIP database

BACKGROUND

Despite Asian Americans having a heightened risk profile for esophageal cancer, racial disparities within this group have not been investigated. This study seeks to evaluate the 30-day postoperative outcomes for Asian Americans following esophagectomy.

METHODS

A retrospective analysis was performed using ACS-NSQIP esophagectomy targeted database 2016-2021. A 1:3 propensity-score matching was applied to Asian Americans and Caucasians who underwent esophagectomy to compare their 30-day outcomes.

RESULTS

There were 229 Asian Americans and 5303 Caucasians identified. Asian Americans were more likely to have squamous cell carcinoma than adenocarcinoma. After matching, 687 Caucasians were included. Asian Americans had higher pulmonary complications (22.27 ​% vs 16.01 ​%, p ​= ​0.04) especially pneumonia (16.59 ​% vs 11.06 ​%, p ​= ​0.04), renal dysfunction (2.62 ​% vs 0.44 ​%, p ​= ​0.01) especially progressive renal insufficiency (1.31 ​% vs 0.15 ​%, p ​< ​0.05), and bleeding events (18.34 ​% vs 9.02 ​%, p ​< ​0.01). In addition, Asian Americans had longer LOS (11.83 ​± ​9.39 vs 10.23 ​± ​7.34 days, p ​= ​0.03).

CONCLUSION

Asian Americans were found to face higher 30-day surgical complications following esophagectomy. Continued investigation into the underlying causes and potential mitigation strategies for these disparities are needed.

Combined Modality Therapy for Management of Esophageal Cancer: Current Approach Based on Experiences from East and West

Human evolutionary genetic divergence and distinctive environmental exposures have contributed to the development of clinicopathologic variations of esophageal cancer in Eastern and Western countries. Different treatment strategies have derived from the disparate regional experiences. Treatment strategy is more standardized in the West. Trimodality treatment with neoadjuvant chemoradiation followed by surgery is widely accepted as the standard treatment of locally advanced esophageal adenocarcinoma and esophageal squamous cell carcinoma. Trimodality treatment has not been adopted in many Eastern countries, and standard treatment is neoadjuvant chemotherapy. Several randomized trials are ongoing that may alter the standard management of esophageal cancer worldwide.

Prognostic value of the number of negative lymph nodes in esophageal carcinoma without lymphatic metastasis

Background

The impact of the number of negative lymph nodes (LNs) on survival in patients with esophageal cancer remains a controversial issue. This study investigated the association between the number of resected LNs and the prognosis of patients with node‐negative esophageal carcinoma.

Methods

A retrospective review was performed of the data of 429 patients who underwent esophagectomy with modern two‐field lymphadenectomy for the treatment of esophageal cancer between January 1998 and December 2008. Histopathology showed no LN involvement in the patient sample. The prognostic impact of the number of negative LNs and the clinicopathological factors were analyzed.

Results

The overall median survival time and the one, three, and five‐year overall survival rates were 63.0 months and 78.5%, 64.0%, and 51.2%, respectively. Survival analysis confirmed that the number of negative LNs and the depth of tumor invasion were independent prognostic factors. Patients with a high number of negative LNs had a better overall survival rate than patients with a low number of negative LNs (P < 0.001). Patients with dissected LNs > 14 for pT1 tumors (P < 0.001) and > 19 for pT2–3 tumors (P < 0.001 and P = 0.001, respectively) had better long‐term survival outcomes.

Conclusions

The number of negative LNs is an independent prognostic factor for node‐negative esophageal carcinoma. Extended LN dissection is recommended to improve the survival of patients with node‐negative esophageal carcinoma.

Incidence and survival differences in esophageal cancer among ethnic groups in the United States

Objectives

This study was performed to identify the differences in incidence, clinicopathological features, and survival in esophageal cancer among ethnic groups in the United States and to determine the reasons for the differences.

Result

A total of 49,766 patients were included. Black and Asian groups had a higher proportion of squamous cell carcinoma (ESCC) (85.5% and 75.4%, respectively) and mid-esophagus tumor (43.2% and 37.7% respectively) than the non-Hispanic white and Hispanic white groups. The incidences of ESCC in all ethnic groups declined since 1973, especially in black males. At the same time, incidences of esophageal adenocarcinoma (EAC) dramatically increased in white males since 1973. And incidences of ESCC and EAC were the lowest and stable in Asian female. Multivariable models showed that patients who were male, or black, or had larger tumors, or positive lymph nodes had an increased risk of death from esophageal cancer, while patients with ESCC or diagnosed after 2005 or treated with surgery had a lower likelihood of death. For ESCC, the black patients had the lowest DSS, while for EAC there were no significant differences in DSS among the ethnic/racial groups.

Materials and Method

From the Surveillance, Epidemiology, and End Results Program database, patients diagnosed with esophageal cancer from 1998-2013 were identified. Differences in incidences, clinicopathological features, treatments, and disease-specific survival (DSS) in four broad racial/ethnic groups were compared.

Conclusion

Histological type distribution between racial groups could be an important consideration in the incidence and the survival trend but other factors could also have an effect.