Racial Factors Cannot Explain Superior Japanese Outcomes in Stomach Cancer

I read with interest the recent publication by Hundahl et al in the February issue of the Archives. 1 The authors compared the stage-stratified survival of Japanese patients treated in Honolulu according to Western techniques with that of Japanese patients treated in Tokyo according to Japanese techniques and observed that survival was better for the Japanese patients in Tokyo. These results cannot be explained by race-related factors because all patients in this study were Japanese. Therefore, the authors suggested that lymphadenectomy-related stage migration or differences in the therapeutic efficacy of the treatment techniques are more likely explanations for the data. Indeed, the application of systemic extended lymph node dissection in the treatment of gastric cancer has been shown to induce substantial stage migration. However, the observed differences are greater than can be ascribed to stage migration alone. 1 Enhanced efficacy of extended lymph node dissection used in the Japanese technique