Presentation and Survival of Gastric Cancer Patients at an Urban Academic Safety-Net Hospital

IntroductionGastric cancer is decreasing nationally but remains pervasive globally. We evaluated our experience with gastric cancer at a safety-net hospital with a substantial immigrant population.MethodsDemographics, pathology, and treatment were analyzed for gastric adenocarcinoma at our institution (2004-2017). Chi-square analyses were performed for dependence of staging on demographics. Survival was evaluated with Kaplan-Meier and Cox regression analyses.ResultsWe identified 249 patients (median age 65years). Patients were predominantly born outside the USA or Canada (74.3%), non-white (70.7%), and federally insured (71.4%), and presented with late-stage disease (52.2%). Hispanic ethnicity, Central American birthplace, Medicaid insurance, and zip code poverty >20% were associated with late-stage presentation (all p<0.05). Univariate analyses showed decreased survival for patients with late-stage disease, highest zip code poverty, and age65 (all p<0.05). On multivariate analysis, survival was negatively associated with late-stage presentation (HR 4.45, p<0.001), age65 (1.80, p=0.018), and H. pylori infection (2.02, p=0.036).ConclusionHispanic ethnicity, Central American birthplace, Medicaid insurance, and increased neighborhood poverty were associated with late-stage presentation of gastric cancer with poor outcomes. Further study of these populations may lead to screening protocols in order to increase earlier detection and improve survival.