Racial differences in colorectal cancer survival at a safety net hospital

Abstract

Background While racial disparity in colorectal cancer survival have previously been studied, whether this disparity exists in patients with metastatic colorectal cancer receiving care at safety net hospitals (and therefore of similar socioeconomic status) is poorly understood. Methods We examined racial differences in survival in a cohort of patients with stage IV colorectal cancer treated at the largest safety net hospital in the New England region, which serves a population with a majority (65%) of non-Caucasian patients. Data was extracted from the hospital's electronic medical record and the survival differences among different racial and ethnic groups were examined graphically using Kaplan-Meier analysis. A univariate cox proportional hazards model and a multivariable adjusted model were generated. Results Black patients had significantly lower overall survival compared to White patients, with median overall survival of 1.9 years and 2.5 years respectively. In a multivariate analysis, Black race posed a significant hazard (HR 1.7, CI 1.01-2.9, p = 0.0467) for death. Though the response to therapy emerged as a strong predictor of survival (HR = 0.4, CI = 0.2-0.7, p = 0.0021), it was comparable between Blacks and Whites. Conclusions Despite presumed equal access to healthcare and socioeconomic status within a safety-net hospital system, our results reinforce the findings from previous studies regarding lower colorectal cancer survival in Black patients, and point to the importance of investigating other risk factors including genetic and pathogenic differences.

Racial disparity in survival of patients diagnosed with early-onset colorectal cancer

“…A meta-analysis [40] revealed that mucinous tumors were 50% more common in the proximal compared with distal colorectum [40]. Our results are in line with other studies suggesting a higher prevalence of mucinous containing tumors in younger age patients [23,24]. In our cohort, mucinous histology tumors were more common in younger AAs versus CAs (i.e., 18 vs 7%), whereas in older patients, we observed the opposite pattern (5 vs 8%).…”

“…Notable differences by race and age in the prevalence of poor prognostic clinicopathologic features in CRCs have been reported [7,[17][18][19][20]. For example, younger AAs often present with a higher stage of disease and more proximal colon cancers (than rectal) compared with younger CAs [7,18], which are associated with poorer prognosis [21,22] Also, mucinous and signet cell histology CRCs are more common in younger age patients [23], including a few reports showing a higher prevalence in younger AAs compared with CAs [17,24]. Mucin containing CRCs occur more frequently in the proximal colon than the rectum and also have poorer prognosis [25,26].…”

c-Cbl Expression Correlates with Human Colorectal Cancer Survival and Its Wnt/β-Catenin Suppressor Function Is Regulated by Tyr371 Phosphorylation

“…Several studies found an association of race on CRC survival. 22,23 Our recent work showed that black patients with mCRC at Boston Medical Center had a significantly lower survival compared with white patients. 23 Therefore, we examined whether the association of c-Cbl expression and survival differed according to race.…”

“…22,23 Our recent work showed that black patients with mCRC at Boston Medical Center had a significantly lower survival compared with white patients. 23 Therefore, we examined whether the association of c-Cbl expression and survival differed according to race. Among black patients with mCRC, those with low and high c-Cbl expression (divided based on median normalized c-Cbl expression) had a median overall survival of 2.1 and 3.8 years, respectively (P Z 0.0284).…”

Genetic factors associated with cancer racial disparity – an integrative study across twenty‐one cancer types

“…It has a greater economic impact from premature death and disability than all causes of death combined worldwide [2]. It is well known that different racial groups have significantly different incidence and mortality rates for certain cancers [3][4][5][6][7][8][9]. For all cancer types combined, the incidence rates in the United States are 465.3, 463.9, and 291.7 per 100 000 people, for non-Hispanic white (NHW), non-Hispanic black (NHB), and Asian/Pacific Islander (API) populations, respectively [1].…”