Abstract
Introduction: Colorectal cancer is one of the most common cancers in the United States. Significant disparities exist among racial and ethnic minorities diagnosed with colorectal cancer compared to non-Hispanic Whites. However, understanding of survival outcomes following curative surgical resection in this population is limited.Objective: To evaluate the association between race and colorectal cancer-specific mortality in patients who were treated with major surgical resection of the colon. Materials and Methods: This study was a retrospective cohort analysis using the Surveillance, Epidemiology, and End Results (SEER) Program database from 2010 to 2016. The patient population consisted of adult patients (≥18 years old) diagnosed with a primary malignancy of colorectal cancer treated with major surgical resection of the colon. The main outcome measures were survival time at one and five years following diagnosis and cancer-specific death.Results: A total of 120,598 patients with primary colorectal malignancy treated with surgical resection of the colon were identified. Across all racial groups, most patients presented with moderately differentiated colorectal cancer. Non-Hispanic Blacks had the highest proportion of diffuse metastases (p<0.001). After adjusting for covariates, Hispanic respondents had the lowest one-year survival (adjusted HR: 1.26, 95%CI (1.21-1.31) and five-year survival when compared to Whites (adjusted HR: 1.13, 95%CI: 1.10-1.15). Factors associated with a shorter survival include age ≥ 70 years old, unmarried status, metastatic disease, and high-grade tumors (p<0.001). Conclusions: Racial disparities exist in the overall survival of patients with colorectal cancer who are treated with surgical resection of the colon. Hispanic patients had the highest hazard of death, followed by Non-Hispanic Asian-Pacific Islanders and Non-Hispanic Blacks, compared to Whites. While surgical resection can be curative, the quality and accessibility of post-operative care may differentiate survival outcomes among racial groups.
Highlights
Colorectal cancer is one of the most common cancers in the United States
Racial disparities exist in the overall survival of patients with colorectal cancer who are treated with surgical resection of the colon
Those that identified as Black had a higher proportion of participants that had moderately differentiated disease (75.0%) and a higher proportion of the population between the ages of 60-69 years (29.0%); whereas those participants who identified as Non-Hispanic Whites (NHW) had a similar proportion of moderately differentiated disease (72.8%), but had a greater proportion of the population over 70 years of age (39.8%)
Summary
Colorectal cancer is one of the most common cancers in the United States. Significant disparities exist among racial and ethnic minorities diagnosed with colorectal cancer compared to nonHispanic Whites. Current projections estimate that the incidence of CRC worldwide will increase to 2.5 million new cases in 2035 [2]. It is the third most common cancer among men and women in the United States (US), with significant disparities between racial and ethnic minorities compared to Non-Hispanic Whites (NHW) [3]. According to the American Cancer Society, minorities are more likely to be diagnosed with cancer and have higher mortality rates compared to the general United States population. The incidence of colorectal cancer is highest in Non-Hispanic Blacks (NHB), with incidence rates approximately 20% greater than NHW and 50% greater than Asian/PIs. [4]
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