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. 2021 Jun 1;113(6):770-777.
doi: 10.1093/jnci/djaa182.

Racial Disparities in Recurrence and Overall Survival in Patients With Locoregional Colorectal Cancer

Rebecca A Snyder  1   2 , Chung-Yuan Hu  3 , Syed Nabeel Zafar  3 , Amanda Francescatti  4 , George J Chang  3   5
Affiliations

Racial Disparities in Recurrence and Overall Survival in Patients With Locoregional Colorectal Cancer

Rebecca A Snyder et al. J Natl Cancer Inst. .

Abstract

Background: The purpose of this study was to determine the association between race and long-term cancer outcomes (recurrence and overall survival) within a population of US patients with locoregional colorectal cancer (CRC).

Methods: A cohort study of primary patient data merged with the National Cancer Database as part of a Commission on Cancer Special Study was performed. The study population was a random sample of patients undergoing surgery for stage I to III CRC between years 2006 and 2007 with 5 years of follow-up. Propensity-weighted multivariable Cox regression was performed with pooled results to yield statistical inferences. Prespecified sensitivity analysis was performed only for patients who received guideline concordant care (GCC) of primary CRC. All statistical tests were 2-sided.

Results: The study population included 8176 patients, 9.9% (n = 811) Black and 90.1% (n = 7365) White. Black patients were more likely to be uninsured or underinsured, have lower household income, and lower educational status (all P < .001). Rates of GCC were higher among Black vs White patients with colon cancer (76.9% vs 72.6%, P = .02), and Black and White patients with rectal cancer were treated with radiation at similar rates (69.1% vs 66.6%, P = .64). Black race was independently associated with increased risk of recurrence (hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.26 to 1.73) and mortality (HR = 1.37, 95% CI = 1.18 to 1.59). In sensitivity analysis of only patients who received GCC, observed effects for recurrence (HR = 1.51, 95% CI = 1.27 to 1.79) and overall survival (HR = 1.40, 95% CI = 1.18 to 1.66) persisted.

Conclusions: Despite higher rates of GCC for CRC, Black patients experience a higher risk of recurrence and mortality compared with White patients.

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Figures

Figure 1.
Figure 1.
Cohort selection for surveillance cohort. CRC = colorectal cancer; NCDB = National Cancer Data Base.
Figure 2.
Figure 2.
Treatment of primary colon and rectal cancer by race. Colon cancer guideline concordant care (GCC) was defined as removal of at least 12 lymph nodes (LN) and all LN negative (American Joint Committee on Cancer stage I or low-risk stage II); or removal of fewer than 12 LN but the patient received adjuvant chemotherapy (high-risk stage II); or removal of at least 12 LN and 1 or more LN positive and the patient received adjuvant chemotherapy (stage III). Rectal cancer GCC was defined as receipt of neoadjuvant or adjuvant radiation in patients with either clinical stage II or III or pathologic stage II or III disease.
Figure 3.
Figure 3.
Regression-adjusted recurrence rates and overall survival rates by tumor site and race (N = 8176).
See this image and copyright information in PMC

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