YIA20-002: Racial Differences in Clinical Histopathological Features and Survival of Early- and Average-Onset Colorectal Cancer

Authors:
Hanyu ChenWashington University School of Medicine, St. Louis, MO
Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Liaoning, P.R. China

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Jie LiuWashington University School of Medicine, St. Louis, MO

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Xiaoyu ZongWashington University School of Medicine, St. Louis, MO

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Ai ZhangWashington University School of Medicine, St. Louis, MO

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Jennifer TappendenWashington University School of Medicine, St. Louis, MO

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Thomas WalshWashington University School of Medicine, St. Louis, MO

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Deyali ChatterjeeWashington University School of Medicine, St. Louis, MO

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Ryan Courtney FieldsWashington University School of Medicine, St. Louis, MO

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Graham Andrew ColditzWashington University School of Medicine, St. Louis, MO
Siteman Cancer Center, Washington University School of Medicine, St Louis, MO

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 MD, DrPH
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Yin CaoWashington University School of Medicine, St. Louis, MO
Siteman Cancer Center, Washington University School of Medicine, St Louis, MO

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 MPH, ScD

Background: The rise of early-onset colorectal cancer (CRC) among non-Hispanic whites (NHW) compared to non-Hispanic blacks (NHB) points to race-specific etiology. Racial differences in clinical characteristics and survival differences for early-onset CRCs remain to be explored. Methods: Data from 4,012 CRC patients treated at the Siteman Cancer Center (2000-2015) was retrieved. We compared patient (insurance, comorbidities, family history of CRC) and clinical characteristics (site, stage, grade, histology), and treatment/surgical outcomes (surgery/radiation/chemotherapy, surgical approach, surgical margins, retrieved lymph nodes) according to race (NHB vs NHW) within 945 early-onset (<50 yr) and 1,580 average-onset CRC cases (≥65 yr), respectively. We then evaluated racial differences in 5-year survival. Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals (CIs). Results: Compared to early-onset CRCs among NHW, NHB cases were more likely to present at the proximal (39% vs 23%) and distal colon (39% vs 33%) but less likely to be at the rectum (23% vs 44%) (P<0.001), while other clinical features were similar. Early-onset NHB CRC patients were less likely to have commercial insurance (47% vs 80%), more likely to enroll in Medicaid (32% vs 12%) or Medicare (9.4% vs 3.5%) (P<0.001), and present with a greater comorbidity score (23% vs 16%) (P=0.048). Five-year survival (crude rate 53% vs 61%) was slightly worse for early-onset NHB compared to NHW cases after adjusting for age, sex, year of diagnosis, and family history (HR=1.26; 95% CI 0.97-1.64), but the differences diminished after further adjustment for insurance, comorbidities, clinical features, treatment, and surgical outcomes (HR=1.12; 95% CI 0.83-1.50). Interestingly, except for advanced stage (IV: 34% vs 16%), minimal differences were observed for site/grade/histology when comparing early- vs average-onset NHB cases (P>0.05). In contrast, for NHW cases, in addition to advanced stages (IV: 33% vs 15%; P<0.001), early-onset CRCs are also more likely to be at the rectum (44% vs 38%) (P<0.001) and show high grade of differentiation (27% vs 22%; P<0.001) compared to NHW CRCs of average-onset. Conclusions: Our findings on differential tumor sites for early-onset NHB vs NHW CRCs as well as more advanced clinical characteristics of early-onset NHW cases compared to those of late-onset together call for deep molecular profiling of both early-onset NHB and NHW CRCs.

Corresponding Author: Yin Cao, MPH, ScD
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