Revisiting gastric cancer disparities in Asian American subgroups: insights from the SEER database.

Background: Gastric cancer disproportionately affects Asian Americans and exhibits substantial heterogeneity across ethnic subgroups. Methods: Patients with gastric cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2021). Results: A total of 16,321 Asian American patients were obtained, with 29% diagnosed at a localized stage. South Asian patients were more likely to be younger, male, married, have cardia tumors, present with low-grade tumors, and receive chemotherapy, and exhibited the most favorable 5-year cancer-specific and overall survival rates across the entire cohort and most subgroups. From 2000-2010 to 2011-2021, survival did not significantly improve among Chinese and Japanese patients, but improved in other Asian American subgroups, as well as White and Black patients, with the greatest gains observed in South Asians. In the most recent decade, South Asians had the highest survival rates, whereas Japanese patients had the lowest, with White and Black patients surpassing Japanese patients. Despite these disparities, clinicopathological trends were largely consistent across subgroups, including increases in localized-stage diagnosis, cardia tumors, and chemotherapy use, alongside decreased use of surgery and radiotherapy. Conclusions: Substantial heterogeneity persists in clinicopathological features, survival, and temporal trends among Asian American subgroups, with South Asian now demonstrating the most favorable survival outcomes and consistent increases in early diagnosis, cardia tumors, and systemic therapy use. These findings help identify factors underlying this heterogeneity and develop strategies to reduce incidence, improve early detection, and mitigate survival disparities.