Does Race Impact Survival for Patients with Anal Squamous Cell Carcinoma?
Vanessa M. Welten MD MPH1*, Adam C. Fields MD1*, Pamela Lu MD1,2, Joel E. Goldberg MD MPH1, Jennifer Irani MD1, Ronald Bleday MD1, Nelya Melnitchouk MD MSc1,2 1Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 2Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, MA *co-first authors
Background:
Racial disparities are known to impact cancer outcomes. The aim of this study was to assess current racial disparities in outcomes and management of anal squamous cell carcinoma (SCC).
Methods:
The National Cancer Database was used to identify patients with anal SCC (2004 to 2013). The primary outcome was five-year overall survival. A cox-proportional hazard model was used to determine independent predictors of survival.
Results:
There were 32,255 (88.1%) White patients and 4,342 (11.9%) Black patients identified with anal SCC. Compared to White patients, Black patients were more likely to be younger, have lower median income, and be insured with Medicaid (all p<0.001). The five-year overall survival of Black and White patients for stage I disease was 71.2% and 80.6% (p<0.001), for stage II disease was 64.6% and 69.3% (p=0.001), for stage III disease was 50.9% and 58.1% (p<0.001), and for stage IV disease was 22.1% and 21.9% (p=0.20). When adjusting for patient and tumor characteristics, Black race was associated with significantly worse survival in stage I (HR:1.37, 95%CI:1.07-1.76, p=0.01), stage II (HR:1.30, 95%CI:1.14-1.48, p<0.001), and stage III disease (HR:1.31, 95%CI:1.16-1.47, p<0.001) but not for stage IV disease (HR:1.09, 95%CI:0.89-1.35, p=0.41).
Conclusion:
Black race is correlated with worse overall survival in patients diagnosed with anal SCC. This disparity in survival is likely multifactorial and may be related to tumor biology and access to care.
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