Socioeconomic and Molecular Factors in CRC Survival

TOPLINE:

Socioeconomic status contributes to 29% of racial disparities in colorectal cancer survival, with molecular factors accounting for 10%. Black patients have worse overall survival than White patients, whereas Asian and Hispanic patients have better outcomes.

METHODOLOGY:

• Researchers conducted a single-center cohort study at a tertiary-level cancer center, including 47,178 patients diagnosed with colorectal cancer from January 1, 1973, to March 1, 2023.
• Analysis included mediation analysis with sequential multivariate Cox regression models to determine the relative contribution of variables to survival disparity.
• Patients’ demographic characteristics and clinical and molecular data were collected from electronic health records and a cancer registry.
• The main outcome was overall survival from diagnosis and from the start of first-line chemotherapy.
• Molecular testing was performed on a subcohort of 7628 patients, using multiple clinically validated institutional multigene panels.

TAKEAWAY:

• Black patients had worse overall survival than White patients, with a hazard ratio of 1.16 (95% CI, 1.09-1.24; P < .001).
• Asian and Hispanic patients had better overall survival than White patients, with hazard ratios of 0.66 (95% CI, 0.59-0.74; P < .001) and 0.86 (95% CI, 0.81-0.92; P < .001), respectively.
• Neighborhood socioeconomic status was the greatest contributor to overall survival disparity, accounting for 29% of the effect.
• Molecular characteristics, including microsatellite instability status, KRAS variation, and BRAF variation, contributed 10% to the overall survival disparity.

IN PRACTICE:

“Our single-institution study is an important complement to large multi-institution registry studies in which cancer stage at diagnosis has been observed to be the major contributor to survival disparity. The relative homogeneity of our cohort allows for investigation of factors driving disparity beyond limitations in colonoscopy screening and access to healthcare,” the authors wrote. “The fact that socioeconomic factors remain the largest contributor to racial and ethnic disparity suggests that low statuses affects health outcomes beyond simple access to quality healthcare.”

SOURCE:

The study was led by John Paul Shen, MD, University of Texas MD Anderson Cancer Center in Houston. It was published online on September 12, 2024, in JAMA Oncology.

LIMITATIONS:

The study’s single-center design may limit the generalizability of the findings to other healthcare settings. The use of self-reported race and ethnicity information as a surrogate for genetic ancestry may have introduced bias. The study did not include patients who identified as American Indian/Alaska Native or Hawaiian or other Pacific Islander due to the small sample size. Approximately 60% of the disparity remained unexplained after adjusting for all available covariates, suggesting the need for more comprehensive molecular profiling.

DISCLOSURES:

Shen disclosed receiving grants from the Cancer Prevention & Research Institute of Texas while conducting the study. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.