Racial Disparities in Recurrence and Overall Survival in Patients with Locoregional Colorectal Cancer
Menée aux Etats-Unis à partir de données portant sur 8 176 patients atteints d'un cancer colorectal de stade locorégional et ayant reçu un traitement chirurgical entre 2006 et 2007, cette étude analyse les disparités ethniques dans le risque de récidive et dans la survie globale (durée de suivi : 5 ans)
Background : The purpose of this study was to determine the association between race and long-term cancer outcomes [recurrence and overall survival (OS)] within a population of U.S. patients with locoregional colorectal cancer (CRC).
Methods : A cohort study of primary patient data merged with the National Cancer Database as part of a Commission on Cancer Special Study was performed. The study population was a random sample of patients undergoing surgery for stage I to III CRC between 2006–2007 with 5 years of follow-up. Propensity-weighted multivariable Cox regression was performed with pooled results to yield statistical inferences. Pre-specified sensitivity analysis was performed of only patients who received guideline concordant care (GCC) of primary CRC. All statistical tests were two-sided.
Results : The study population included 8,176 patients, 9.9% (n = 811) Black and 90.1% (n = 7,365) White. Black patients were more likely to be uninsured or underinsured, have lower household income, and lower educational status (all p < .001). Rates of guideline concordant care were higher among Black vs. White patients with colon cancer (76.9% vs 72.6%, p = .02), and Black and White patients with rectal cancer were treated with radiation at similar rates (69.1% vs. 66.6%, p = .64). Black race was independently associated with increased risk of recurrence (HR = 1.48, 95%CI = 1.26–1.73) and mortality (HR = 1.37, 95%CI = 1.18–1.59). In sensitivity analysis of only patients who received GCC, observed effects for recurrence [HR = 1.51 (95%CI = 1.27–1.79)] and OS [HR = 1.40 (95%CI = 1.18–1.66)] persisted.
Conclusion : Despite higher rates of GCC for CRC, Black patients experience a higher risk of recurrence and mortality compared to White patients.
Journal of the National Cancer Institute , résumé, 2019