S3442 Gastric Cancer: Epidemiology and Diagnosis in the Non-Hispanic White Population at a Tertiary Medical Center

Backgrounds/Aims. Watson for Oncology (WFO) is a cognitive technology that processes medical information by analyzing the latest evidence and guidelines. However, studies of the concordance rate between WFO and clinicians for advanced gastric cancer (AGC) are lacking.Methods. We retrospectively reviewed 65 patients with AGC who consulted WFO and the Gachon Gil Medical Center multidisciplinary team (GMDT) in 2016 and 2017. The recommendations of WFO were compared with the opinions of the GMDT. WFO provided three treatment options: recommended (first treatment option), for consideration (second treatment option), and not recommended.Results. In total, 65 patients (mean age 61.0 years; 44 males and 21 females) were included in the study. The concordance rate between WFO and the GMDT was 41.5% (27/65) at the recommended level and 87.7% (57/65) at the for consideration level. The main causes of discordance between WFO and the GMDT were as follows. First, WFO did not consider the medical history. Second, WFO recommended the use of agents that are considered outdated in Korea. Third, some patients wanted to be involved in a clinical trial. Fourth, some patients refused to use the biologic agents recommended by WFO for financial reasons as they were not covered by medical insurance.Conclusions. The concordance rate at the recommended level was relatively low but was higher at the for consideration level. Discordances arose mainly from the different medical circumstances at the Gachon Gil Medical Center (GMC) and the Memorial Sloan Kettering Cancer Center (MSKCC), the main WFO consulting center. The utility of WFO as a tool for supporting clinical decision making could be further improved by incorporating regional guidelines.

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Gastric cancer: epidemiology, prevention, and therapy

Helicobacter ◽

10.1111/hel.12518 ◽

2018 ◽

Vol 23 ◽

pp. e12518 ◽

Cited By ~ 52

Author(s):

Marino Venerito ◽

Riccardo Vasapolli ◽

Theodoros Rokkas ◽

Peter Malfertheiner

Keyword(s):

Gastric Cancer ◽

Cancer Epidemiology ◽

Prevention And Therapy

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Unexpected CDH1 Mutations Identified on Multigene Panels Pose Clinical Management Challenges

JCO Precision Oncology ◽

10.1200/po.16.00021 ◽

2017 ◽

pp. 1-12 ◽

Cited By ~ 7

Author(s):

Katrina Lowstuter ◽

Carin R. Espenschied ◽

Duveen Sturgeon ◽

Charité Ricker ◽

Rachid Karam ◽

...

Keyword(s):

Gastric Cancer ◽

Medical Management ◽

Cancer Genetics ◽

Medical Center ◽

Academic Medical Center ◽

Lifetime Risk ◽

Diffuse Gastric Cancer ◽

Mutation Carriers ◽

Cdh1 Mutation ◽

Testing Criteria

Purpose Mutations in the CDH1 gene confer up to an 80% lifetime risk of diffuse gastric cancer and up to a 60% lifetime risk of lobular breast cancer. Testing for CDH1 mutations is recommended for individuals who meet the International Gastric Cancer Linkage Consortium (IGCLC) guidelines. However, the interpretation of unexpected CDH1 mutations identified in patients who do not meet IGCLC criteria or do not have phenotypes suggestive of hereditary diffuse gastric cancer is clinically challenging. This study aims to describe phenotypes of CDH1 mutation carriers identified through multigene panel testing (MGPT) and to offer informed recommendations for medical management. Patients and Methods This cross-sectional prevalence study included all patients who underwent MGPT between March 2012 and September 2014 from a commercial laboratory (n = 26,936) and an academic medical center cancer genetics clinic (n = 318) to estimate CDH1 mutation prevalence and associated clinical phenotypes. CDH1 mutation carriers were classified as IGCLC positive (met criteria), IGCLC partial phenotype, and IGCLC negative. Results In the laboratory cohort, 16 (0.06%) of 26,936 patients were identified as having a pathogenic CDH1 mutation. In the clinic cohort, four (1.26%) of 318 had a pathogenic CDH1 mutation. Overall, 65% of mutation carriers did not meet the revised testing criteria published in 2015. All three CDH1 mutation carriers who had risk-reducing gastrectomy had pathologic evidence of diffuse gastric cancer despite not having met IGCLC criteria. Conclusion The majority of CDH1 mutations identified on MGPT are unexpected and found in individuals who do not fit the accepted diagnostic testing criteria. These test results alter the medical management of CDH1-positive patients and families and provide opportunities for early detection and risk reduction.

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Cancer stage at diagnosis, treatment, and survival among US- and foreign-born Asians and Pacific Islanders with gastric cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15018 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15018-15018

Author(s):

S. DaCosta Byfield ◽

C. C. Earle ◽

D. Li ◽

J. Z. Ayanian ◽

E. P. McCarthy

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Pacific Islanders ◽

Cancer Stage ◽

Stage At Diagnosis ◽

Foreign Born ◽

Increased Risk ◽

Lymph Node Assessment ◽

Adequate Lymph Node ◽

Hispanic White

15018 Background: Asians and Pacific Islanders (APIs) have increased risk of developing gastric cancer, but whether cancer treatments and outcomes vary by birthplace is unknown. We examined the association between birthplace and cancer stage at diagnosis, treatment, and survival comparing API and non-Hispanic white (NHW) patients. Methods: We studied 6840 NHW and 4485 API patients diagnosed with gastric cancer from the Surveillance, Epidemiology and End Results Program between 1992 and 2003. We used bivariable analyses to compare stage, receipt of adequate lymph node assessment and surgery across groups: US-born APIs, foreign-born (FB) APIs and NHWs. We used multivariable polychotomous logistic and proportional hazards regression models to determine differences between US-born and FB APIs compared to NHWs in cancer stage and survival, respectively. Models included age, marital status, tumor grade, location, and stage (survival only). Results: Of API patients, 29% were US-born, 49% FB and 22% of unknown birthplace. APIs were more likely than NHWs to present with earlier-stage diagnoses and receive surgery and adequate lymph node assessment (p<0. 001). After adjustment, US-born [aOR=0.86 (0.75–0.93)] and FB APIs [aOR=0.76 (0.68–0.84)] were less likely to present at later stages than NHWs. Among APIs, FB patients had fewer lymph node assessed than US-born (p<0.001), but were as likely to present with earlier stage disease and receive surgery. After adjustment, US-born [aHR= 0.90 (0.85–0.98)] and FB APIs [(aHR= 0.85 (0.78–0.92)] had higher survival rates than NHWs. Results were similar after adjusting for treatment. *p <0.001 for comparison with NHW +p>0.05 for comparison among API Conclusions: Compared to US-born APIs, FB API patients with gastric cancer present at later stages and are less likely to receive adequate surgical lymph node assessment. However, both US-born and FB API patients present at earlier stages and experience better survival than non-Hispanic white patients. [Table: see text] No significant financial relationships to disclose.

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