Peritoneal carcinomatosis in gastric cancer: Are Hispanics at higher risk?

BACKGROUND: A recent study from our group identified Hispanic race/ethnicity as an independent predictor of peritoneal carcinomatosis (PC) in gastric cancer. We sought to identify the tumor factors that might contribute to this strong association in Hispanics. METHODS: California Cancer Registry data were used to identify patients diagnosed with gastric adenocarcinoma from 2004 to 2014. Logistic regression analyses were performed to determine odds ratios for cancer stage, tumor location, grade, histology, and PC. RESULTS: Of 16,275 patients with gastric adenocarcinoma who met inclusion criteria, 6463 (39.7%) were non-Hispanic White (NHW), 4953 (30.4%) were Hispanic, 1020 (6.3%) were non-Hispanic Black (NHB), and 3915 (23.6%) were Asian/other. Compared to NHW, Hispanics were more likely to have a poorly differentiated grade (65.9% vs. 57.6%; p < .001), signet ring adenocarcinoma (28.1% vs. 17.6%; p < .001) and stage IV (51.9% vs. 45.0%; p < .001) gastric cancer. The proportion of stage IV patients with PC was also significantly higher in Hispanics compared to NHW, NHB, and Asian/other (28.5% vs. 16.6%, 20.5%, and 25.2%, respectively; p < .001). CONCLUSIONS: Hispanic ethnicity is an independent predictor of aggressive tumor phenotype and PC. Disproportionate incidence of signet ring adenocarcinoma and PC highlight the need to explore the genomic differences in Hispanic gastric cancer.

Mucosal Vaccination against Enteric Pathogens in the Developing World.

Of the approximately 9 million children under the age of 5 yr that die annually in developing nations, about 5.1 million will die from preventable infectious diseases. This disastrous human and economic loss is caused in large part by three types of acute diarrhea and attendant respiratory tract infections that are responsible for approximately 2.6 million of these deaths. Thus, enteric pathogens remain a major factor contributing to persistent poverty and poor health in developing nations. Novel mucosal vaccination strategies are emerging that can protect epithelial surfaces and therefore promise a simple, effective and safe interventional therapy to overcome the mortality generated by these debilitating infectious diseases. Before the full potential for mucosal vaccination against enteric diseases can be realized, the innate immune system must be strengthen by addressing secondary problems such as malnutrition, malabsorption and gastrointestinal tract impairment. Here we describe the major enteric pathogens responsible for childhood morbidity and mortality in developing and resource-limited countries. We also discuss the development of mucosal vaccination strategies that when combined with modern principles of nutritional therapy may help improve the health and socio-economic status of developing nations.