A0687 - The Epidemiology of Gastric Cancer in the United States: A Population-Based Study

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Khaled Alsabbagh Alchirazi, MD

Cleveland Clinic
Cleveland, OH

Award: Presidential Poster Award

Khaled Alsabbagh Alchirazi, MD¹, Abdul Mohammed, MD¹, Ahmed Eltelbany, MD, MPH¹, Rajat Garg, MD², Almaza A. Albakri, MD³, Madhusudhan Sanaka, MD⁴, Prashanthi Thota, MD⁵
¹Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³Royal Jordanian Medical Services, Amman, Al Karak, Jordan; ⁴Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH; ⁵Cleveland Clinic, Cleveland, OH

Introduction: Gastric cancer is the third leading cause of cancer-related mortality in the world. Although various epidemiologic and clinical characteristics are reported to be associated with the development of gastric cancer, there are no large studies that demonstrate their relative risk of gastric malignancy. Our study describes the prevalence of gastric cancer in the US population and quantifies the risk factors associated with the development of gastric cancer.

Methods: We used a multi-institutional database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) with a diagnosis of primary malignant neoplasm of the stomach and compared them with individuals without a diagnosis of gastric cancer. Epidemiologic characteristics and risk factors for the development of gastric cancer were recorded for each group and compared. A univariate binary logistic model was constructed using gastric cancer as the dependent variable.

Results: Of the 70, 301,380 individuals in the database between 1999 to 2022, we identified 34,370 (0.04%) patients with primary malignant neoplasm of the stomach. Demographic characteristics such as elderly ( >65 years), male gender, Asian, African American, and Caucasian races were at higher odds of gastric cancer when compared with controls (p < 0.0001). Risk factors such as hypertension, diabetes mellitus, obesity, coronary atherosclerosis, end-stage renal disease, cirrhosis, congestive heart failure, alcohol abuse, tobacco use, family history of gastrointestinal cancer, H. pylori infection, history of gastritis, history of gastric ulcer, history of pernicious anemia and history of chronic atrophic gastritis were all associated with higher odds of gastric cancer (P < 0.0001). Finally, patients with history of intestinal polyposis syndrome were more likely to have gastric cancer (P = 0.0001) (table 1).

Discussion: In our large cohort of patients with primary malignant neoplasm of the stomach, we demonstrate an increased association of gastric cancer with several epidemiological and clinical risk factors. In the absence of screening practices, our study can help guide decision-making and facilitate the early diagnosis of gastric cancer.

	Gastric cancer n=34,370 (%)	No Gastric cancer n=70,306,690 (%)	OR (CI)	p-value
Demographics
Age >65	24,160 (70%)	47,922,349 (68%)	1.11 (1.08-1.13)	< 0.0001
Male	20,780 (60%)	31,380,250 (45%)	1.89 (1.86-1.94)	< 0.0001
Caucasian	22,780 (66%)	37,812,540 (54%)	1.69 (1.65-1.73)	< 0.0001
African American	5,560 (16%)	7,014,930 (10%)	1.74 (1.69 to 1.79)	< 0.0001
Asian	1,430 (4%)	1,119,980 (2%)	2.68 (2.54 to 2.83)	< 0.0001
Comorbidities
T2DM	9,570 (28%)	5,637,530 (8%)	4.43 (4.32-4.53)	< 0.0001
HTN	7,290 (21%)	3,493,560 (5%)	5.15 (5.02-5.28)	< 0.0001
Obesity	5,170 (15%)	5,431,330 (8%)	2.12 (2.05-2.18)	< 0.0001
Tobacco use	6,610 (2%)	6,481,490 (9%)	2.35 (2.28-2.41)	< 0.0001
Cirrhosis	7,290 (21%)	3,493,500 (5%)	5.15 (5.02-5.28)	< 0.0001
Coronary atherosclerosis	8,920 (26%)	3,724,220 (5%)	6.27 (6.12-6.42)	< 0.0001
CHF	5,030 (15%)	1,829,140 (3%)	6.42 (6.23-6.61)	< 0.0001
ESRD	910 (3%)	416,780 (1%)	4.56 (4.27-4.87)	< 0.0001
Alcohol abuse	1,500 (4%)	1,088,380 (2%)	2.87 (2.73-3.02)	< 0.0001
Risk factors of Gastric cancer
Family history of GI cancer	1,880 (6%)	593,480 (1%)	6.79 (6.49-7.12)	< 0.0001
H. pylori infection	430 (1%)	92,720 (0.13%)	9.59 (8.72-10.55)	< 0.0001
History of gastritis	9,520 (28%)	3,322,240 (5%)	7.72 (7.54-7.91)	< 0.0001
History of gastric ulcer	4,580 (13%)	354,050 (1%)	30.38 (29.44-31.34)	< 0.0001
History of pernicious anemia	680 (2%)	81,310 (0.12%)	17.43 (16.15-18.81)	< 0.0001
History of chronic atrophic gastritis	2,380 (7%)	261,220 (0.4%)	19.95 (19.13-20.80)	< 0.0001
History of intestinal polyposis syndrome	10 (0.03%)	6,060 (0.01%)	3.38 (1.82-6.28)	= 0.0001

Table: Table 1. Comparison of baseline characteristics and outcomes Primary malignant neoplasm of the stomach patients.
table 1: Univariate analysis used to calculate OR, OR; odds ratio, CI; confidence interval, T2DM; type 2 diabetes mellitus, HTN; Hypertension, ESRD; end stage renal disease, CHF; congestive heart failure. GI; Gastrointestinal.

Disclosures:

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Ahmed Eltelbany indicated no relevant financial relationships.

Rajat Garg indicated no relevant financial relationships.

Almaza Albakri indicated no relevant financial relationships.

Madhusudhan Sanaka indicated no relevant financial relationships.

Prashanthi Thota indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi, MD¹, Abdul Mohammed, MD¹, Ahmed Eltelbany, MD, MPH¹, Rajat Garg, MD², Almaza A. Albakri, MD³, Madhusudhan Sanaka, MD⁴, Prashanthi Thota, MD⁵. A0687 - The Epidemiology of Gastric Cancer in the United States: A Population-Based Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.