Socioeconomic status based on race in early-stage anal squamous cell carcinoma undergoing locoregional therapy.

Abstract

4056 Background: Anal Squamous Cell Cancer (ASCC) is a highly curable cancer. Underserved and vulnerable populations are particularly at risk of developing this disease. We aimed to study racial disparities and overall survival (OS) in patients with ASCC who received radiation therapy (RT) or chemo-RT (CRT) using the National Cancer Database. Methods: We identified adult patients with early-stage (stage I-II) ASCC diagnosed between 2004-2016 who underwent RT or CRT. We compared the clinical and treatment characteristics of white and black patients. The chi-square test was used for categorical variables. Kaplan-Meier and Cox regression method performed for survival analyses. We used 1:1 nearest neighbor propensity score matching to eliminate selection bias. Results: A total of 10,014 patients; 90.2% were white and 9.8% were black. White patients were more likely to be female, older age, have higher rate high-school education, private insurance, higher income, and travel a longer distance (all p < .001). Black patients were more likely to be higher comorbidity score and be treated at an academic/research facility. White patients had a higher rate of CRT and significantly better overall survival (OS) as compared to black patients (5-year survival 76% vs. 70%, p < .001) which persisted after propensity score matching (5-year survival 76% vs. 70%, p = .002). This difference continued after adjusting for clinically important factors, including HPV status (unmatched p < .03, matched p = .008). In the patients who received CRT, white patients were associated with improved OS versus black patients (unmatched 77% vs. 71%, p < .001; matched 77% vs. 71%, p = .011), and even after multivariate Cox analysis (unmatched p < .001; matched .014) (Table). Conclusions: White patients had significantly better OS as compared to black patients with early-stage ASCC as well as in the patients who received CRT. White patients were associated with high education level, higher income, and private insurance. The rate of HPV positive was similar among groups. Further investigations are needed to enlighten these disparities and target the increase education of the population at risk. [Table: see text]