Racial Differences in Stage IV Colorectal Cancer Survival in Younger and Older Patients

Abstract

Introduction African Americans (AA) compared to European Americans (EA) have poorer stage specific survival from colorectal cancer (CRC). Recent reports have indicated that the racial difference in survival has worsened over time, especially among younger patients. To better characterize this association, we used population-based SEER registry data to evaluate the impact of race on stage IV CRC survival in patients < 50 and ≥ 50. Patients and Methods The population was comprised of 16,782 patients diagnosed with stage IV colon and rectal adenocarcinoma between 01 January 2004 and 31 December 2011. Cox proportional hazards regression was used to evaluate the association between race and other prognostic factors and the risk of death in each age group. Results Younger AAs compared to EAs had a higher prevalence of proximal CRC at diagnosis, a factor associated with significantly higher risk of death in both races. Among patients < 50 years of age, AAs had a higher risk of death compared to EAs (HR 1.35, 95% CI 1.20 to 1.51)), which was attenuated in patients ≥ 50 years of age (HR 1.10, 95% CI 1.04 to 1.16); p for interaction 0.01. Conclusion The results revealed poor overall survival in AA compared to EA, especially in those < 50 years of age. The higher prevalence of proximal CRC at diagnosis among younger aged AA (vs. EA) may contribute to the racial difference in survival. Future studies will be needed to understand how colonic location impacts the efficacy of treatment regimens.

Racial Disparities in Incidence of Young-Onset Colorectal Cancer and Patient Survival

“…Prior studies also have shown racial differences in colon cancer survival are concentrated in younger (vs older) adults, 5,[32][33][34][35] even after adjusting for confounders, such as treatment receipt. 5,[32][33][34][35][36] Because screening has not been recommended in this younger population, the racial disparities in relative survival that we and others have observed are unlikely to be the result of differential uptake of screening. In consequence, our findings raise a number of questions concerning the contribution of treatment 37,38 and therapeutic response 39,40 to racial differences in relative survival, which also might differ for colon and rectal cancers.…”

Tumor-Infiltrating Lymphocytes and Colorectal Cancer Survival in African American and Caucasian Patients

“…Several studies have reported that younger AAs have poorer prognosis than younger CAs (2, 3, 5, 31) and that the racial disparity is less pronounced in older patients. Our findings suggest a differential impact of lymphocyte score on survival in younger and older AA patients.…”

“…Therefore, in the current study, we examined the differences in the lymphocyte reaction score in the colorectal cancers of AAs and CAs, and evaluated the impact on survival while adjusting for potential confounders such as age, sex, stage, treatment, and colorectal cancer tumor-related features. Because many have identified a greater survival disparity in younger AAs compared with younger CAs, we also evaluated the association of the lymphocyte score on survival by race in younger and older patients (2, 3, 4, 5, 31).…”

Shorter survival in adolescent and young adult patients, compared to adult patients, with stage IV colorectal cancer in Japan

“…[ 21 ] Another study reported poorer OS in African American patients with stage IV CRC compared with European American patients, especially among those aged ≤50 years. [ 22 ] These reports suggest that racial differences affect survival in younger patients with stage IV CRC. At present, no detailed outcome data are available for other races, including Asians.…”