Survival associated with metastatic early-onset colorectal cancer among Black patients: A real-world account.

Abstract

39 Background: Early-onset colorectal cancer (EOCRC), defined as colorectal cancer (CRC) diagnosed under the age of 50, is a growing health concern. The current study explored the racial differences in EOCRC survival in the United States (US). Methods: This retrospective cohort study was conducted using the TriNetX database, a platform that provides access to deidentified medical records on more than 130 million patients across 94 healthcare organizations in the US. The study cohort included patients with metastatic CRC (mCRC), aged 20 to 50, diagnosed between January 1, 2002, and January 1, 2020, and received frontline chemotherapy with oxaliplatin and 5- fluorouracil or capecitabine. The cohort was divided into Black or African American cohort and White cohort. The primary endpoint, 5-year overall survival (OS), was compared between these cohorts after performing 1:1 propensity score matching (PSM) for baseline demographics and comorbid conditions (Table). Kaplan-Meier curves, log-rank chi-square statistics, and hazard ratios (HR) were used to compare the outcome. Results: The entire cohort consisted of 2,923 patients with a mean age of 44 (±6) years; 48.58% were female. The majority were white (56.38%), followed by 15.56% of unknown race, Black/African American (9.16%), Hispanic (9.34%), and Asian (8.96%). After propensity score matching (PSM), there were 262 patients in both the Black and White groups. In the matched population, the Kaplan-Meier survival curves showed that Black patients had significantly lower 5-year OS rates (24.84%) compared to White patients (33.76%) [Hazard Ratio (HR): 1.39, 95% CI (1.06, 1.85), p<0.05]. There is no significant difference between Black and White population over age of 50 [ HR: 1.06, 95% CI (0.966-1.179), P=0.2]. Conclusions: Survival among Black patients with EOCRC appears to be worse than White patients despite adjustment for confounding variables, supporting further research focusing onto this patient population. Characteristics of the cohorts before and after matching. Black cohort (n = 265) and White cohort (n = 1,632) characteristics before propensity score matching Black cohort (n = 262) and White cohort (n = 262) characteristics after propensity score matching Black patients, n (%) White patients, n (%) Sth diff. Black Patients, n (%) White patients, n (%) Sth diff. Age (Mean ± SD) 36.2 ± 6.18 36.3 ± 6.01 0.022 36.1 ± 6.17 36.2 ± 6.43 0.013 Female 144 (54.5%) 774 (47.4%) 0.142 143 (54.5%) 143 (54.5%) <0.0001 Tobacco use 15 (5.6%) 96 (5.8%) 0.0087 15 (5.7%) 11 (4.2%) 0.0703 Hypertensive diseases 67 (25.3%) 214 (13.12%) 0.3147 65 (24.8%) 64 (24.4%) 0.0089 Ischemic heart diseases 10 (3.7%) 40 (2.4%) 0.0769 10 (3.8%) 10 (3.8%) < 0.0001 Type 2 diabetes mellitus 24 (9%) 89 (5.4%) 0.1403 22 (8.3%) 19 (7.2%) 0.0426 Diseases of arteries, arterioles and capillaries 12 (4.5%) 47 (2.8%) 0.0881 11 (4.1%) 10 (3.8%) 0.0195