Holowatyj Andreana N, Ruterbusch Julie J, Rozek Laura S, Cote Michele L, Stoffel Elena M
Andreana N. Holowatyj, Julie J. Ruterbusch, and Michele L. Cote, Wayne State University School of Medicine; Andreana N. Holowatyj and Michele L. Cote, Barbara Ann Karmanos Cancer Institute, Detroit; Laura S. Rozek, University of Michigan School of Public Health; and Elena M. Stoffel, University of Michigan Health System, Ann Arbor, MI.
J Clin Oncol. 2016 Jun 20;34(18):2148-56. doi: 10.1200/JCO.2015.65.0994. Epub 2016 May 2.
Racial disparities in colorectal cancer (CRC) persist, despite overall reductions in morbidity and mortality. In addition, incidence is rising among individuals younger than 50 years of age. We compared the survival of young-onset CRC among non-Hispanic black (NHB), non-Hispanic white (NHW), and Hispanic individuals.
Using the National Cancer Institute's Surveillance, Epidemiology, and End Results program data, we identified individuals between the ages of 20 and 49 years, diagnosed with CRC between 2000 and 2009. Survival rates and Cox proportional hazards models were used to compare stage-specific 5-year survival among NHBs, NHWs, and Hispanics.
We identified 28,145 patients with young-onset CRC (19,497 NHW; 4,384 NHB; 4,264 Hispanic) during the 10-year study period. Overall survival at 5 years after CRC diagnosis was 54.9% among NHB, 68.1% among NHW, and 62.9% among Hispanic individuals (P < .001). NHB individuals had a significantly higher hazard of cancer-specific death compared with NHWs after adjusting for age, sex, race, stage, county-level poverty, and treatment history in cases of colon (hazard ratio [HR], 1.35; 95% CI 1.26 to 1.45) and rectum/rectosigmoid junction (HR, 1.51; 95% CI, 1.37 to 1.68) cancers, whereas there was no significant difference in survival between NHWs and Hispanics. The greatest racial disparities in cancer-specific survival were observed among NHB and NHW patients diagnosed with stage II cancers of the colon (HR, 1.69; 95% CI, 1.33 to 2.14) and stage III cancers of the rectum (HR, 1.98; 95% CI, 1.63 to 2.40).
Survival after CRC diagnosis at a young age is significantly worse among NHBs compared with NHWs, even among patients with early-stage disease. Further study is needed to determine whether differences in tumor biology and/or treatment are associated with racial disparities in outcomes, which would have implications for CRC treatment and prevention.
尽管结直肠癌（CRC）的发病率和死亡率总体有所下降，但种族差异仍然存在。此外，50岁以下人群的发病率正在上升。我们比较了非西班牙裔黑人（NHB）、非西班牙裔白人（NHW）和西班牙裔人群中年轻发病的CRC患者的生存率。
利用美国国立癌症研究所的监测、流行病学和最终结果计划数据，我们确定了2000年至2009年间年龄在20至49岁之间、被诊断为CRC的个体。生存率和Cox比例风险模型用于比较NHB、NHW和西班牙裔人群中特定分期的5年生存率。
在10年的研究期内，我们确定了28145例年轻发病的CRC患者（NHW患者19497例；NHB患者4384例；西班牙裔患者4264例）。CRC诊断后5年的总生存率在NHB患者中为54.9%，在NHW患者中为68.1%，在西班牙裔患者中为62.9%（P <.001）。在调整了年龄、性别、种族、分期、县级贫困程度和治疗史后，NHB患者在结肠癌（风险比[HR]，1.35；95%可信区间1.26至1.45）和直肠/直肠乙状结肠交界处癌（HR，1.51；95%可信区间，1.37至1.68）中癌症特异性死亡风险显著高于NHW患者，而NHW患者和西班牙裔患者的生存率没有显著差异。在诊断为结肠癌II期（HR，1.69；95%可信区间，1.33至2.14）和直肠癌III期（HR，1.98；95%可信区间，1.63至2.40）的NHB和NHW患者中，观察到最大的癌症特异性生存种族差异。
与NHW患者相比，NHB患者在年轻时诊断为CRC后的生存率明显更差，即使是早期疾病患者也是如此。需要进一步研究以确定肿瘤生物学和/或治疗方面的差异是否与结局的种族差异相关，这将对CRC的治疗和预防产生影响。
