Racial Disparities in Preoperative Chemotherapy Use in Gastric Cancer Patients in the United States: Analysis of National Cancer Database 2006-2014

PURPOSE No studies have investigated whether race/ethnicity is associated with the recommended use of preoperative chemotherapy or subsequent outcomes in gastric cancer. To determine whether there is such an association, we conducted analyses of gastric cancer patients in the National Cancer Database.^ METHODS Patients with clinical T2-4bN0-1M0 gastric adenocarcinoma, as defined by the American Joint Committee on Cancer staging manual, 8th edition, who underwent gastrectomy during 2006 through 2014 were identified from the National Cancer Database. Multiple logistic regression was conducted to examine factors associated with preoperative chemotherapy use.^ RESULTS We identified 16,945 patients who met study criteria, of whom 8,286 (49%) underwent preoperative chemotherapy. The use of preoperative chemotherapy remarkably increased over the study period, from 34% in 2006 to 65% in 2014. Preoperative chemotherapy was more commonly used in cardia tumors than in non-cardia tumors (83% vs. 44%, in 2014). On multivariable analysis, races/ethnicities other than non-Hispanic white were associated with less frequent use of preoperative chemotherapy compared with non-Hispanic white after adjustment for social/tumor/hospital factors. Insurance status, education level, and treatment at non-academic hospital mediated an enhanced effect of racial/ethnic disparity in preoperative chemotherapy use. Use of preoperative chemotherapy and radiation therapy was associated with reduced racial/ethnic disparity in overall survival. ^ CONCLUSION Racial/ethnic disparity in the use of preoperative chemotherapy and outcomes exists among gastric cancer patients in the United States.