Postsurgical disparity in survival between African Americans and Caucasians with colonic adenocarcinoma

Abstract

Colorectal carcinoma (CRC) is the third most common malignancy and the second most common cause of cancer mortality among men and women in the United States. In 2003, there were an estimated 147,500 new cases of CRC and 57,100 deaths due to this malignancy.1 In the United States, there are racial differences in CRC incidence, mortality, and survival. Compared with Caucasians, African Americans have higher incidence and mortality rates and lower survival rates.2 Recent trends indicate that the incidence of CRC among Caucasians has declined slightly and recently stabilized, whereas CRC incidence among African Americans has increased. The racial discrepancy is even more prominent with respect to mortality: Mortality rates have declined steadily for Caucasians, whereas they have increased for African Americans, and particularly African-American men. For each disease stage at diagnosis, 5-year relative survival rates are lower for African Americans with CRC than for Caucasians.2 Several studies of survival differences between African-American and Caucasian patients with CRC have reported poorer prognosis and shorter survival among the former group3–15 (Table 1). These studies analyzed survival and/or mortality among patients with colonic, rectal, or colorectal carcinoma (patients with colonic and rectal tumors were analyzed as a single group). A variety of explanations for the racial disparity in survival have been proposed, including differences in age, advanced disease stage at the time of diagnosis, treatment options, socioeconomic factors, and biologic characteristics (Table 1). TABLE 1 Review of Studies Evaluating Differences in Survival between African Americans and Caucasians with Colorectal Adenocarcinoma We conducted survival analyses to elucidate the differences in survival between African-American patients and Caucasian patients with CRC based on tumor site and tumor stage, because neoplasia of the colon and the rectum should be viewed as distinct disease entities, each with their own prognostic factors. All patients underwent surgery (alone) with curative or palliative intent at the University of Alabama–Birmingham (UAB; Birmingham, AL) or at an affiliated Birmingham Veterans Affairs (VA) hospital. The current clinical cohort of patients may represent the population dynamics of the southeastern United States.