Abstract B114: The absolute need for impartial care: Aggressive surgery and local therapy provide equitable care across diverse patient populations for advanced colorectal cancer
Authors: Freudenberger Devon C. , Wolfe Luke , Riner Andrea N. , Vudatha Vignesh , Herremans Kelly M. , Fernandez Leopoldo J. , Trevino Jose G. 
Published: January 2023

Abstract
Introduction: Survival for patients with peritoneal metastasis from colorectal cancer is poor, but can be improved in highly selected patients with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Advanced cancer states tend to create racial/ethnic disparities. Little is known about racial/ethnic disparities in patients with colorectal cancer peritoneal metastasis managed with CRS/HIPEC. In this study we examine the impact of race/ethnicity of patient outcomes and overall survival after CRS/HIPEC. Methods: Data were extracted from the National Cancer Database 2019 Participant User File for adult patients with colorectal cancer managed with CRS/HIPEC from 2006-2018. Patients were classified by racial/ethnic groups: non-Hispanic White, non-Hispanic Black, Hispanic, and Other. Differences in sociodemographics, treatment course, tumor characteristics, and postoperative outcomes were evaluated using Χ2 and Kruskal-Wallis tests. Kaplan-Meier survival analysis and Log-rank tests were used to assess for differences in survival. Cox Regression was used for evaluating predictors of overall survival. Results: 732 patients with colorectal cancer underwent CRS/HIPEC, of which 573 (78.3%) were White, 91 (12.4%) were Black, 39 (5.3%) were Hispanic, and 29 (4.0%) were Other. There were significant differences by race/ethnicity in patient sex, insurance payor, distance traveled to facility, location, education level, and income. There was, however, no difference in patient age, cancer treatment facility type, or year of diagnosis. Patients had similar amounts of comorbidities with the majority of patients having a Charlson-Deyo score of 0 (p=0.6882). Surgical management with CRS/HIPEC was similar across all groups in terms of median days from diagnosis to surgery. Tumor grade and surgical margins were also similar. Postoperative outcomes including hospital length of stay, rates of readmission, 30 and 90-day mortality were not different. Patients had similar lengths of follow-up. Median overall survival was 40.1 months for White patients, 45.5 months for Black patients, 44.1 months for Hispanic patients, and 64.1 months for Other patients. Overall survival was not statistically different between racial/ethnic groups (p=0.1922). Multivariate survival analysis showed that race/ethnicity was not a predictor of survival; however, tumor grade (Poorly differentiated: HR 2.031 [1.309, 3.151], p=0.0016; Undifferentiated: HR 2.284 [1.297, 4.021], p=0.0042) and surgical margins (R2 resection: HR 1.954 [1.186, 3.221], p=0.0086) were significant predictors of survival. Conclusions: Advanced colorectal disease with peritoneal involvement can be managed aggressively with CRS/HIPEC and improve patient overall survival. Similar outcomes are possible for different racial/ethnic groups despite differences in patient sociodemographic factors. CRS/HIPEC for colorectal peritoneal disease should be viewed as an equitable management option for diverse patient populations.
Citation Format: Devon C. Freudenberger, Luke Wolfe, Andrea N. Riner, Vignesh Vudatha, Kelly M. Herremans, Leopoldo J. Fernandez, Jose G. Trevino. The absolute need for impartial care: Aggressive surgery and local therapy provide equitable care across diverse patient populations for advanced colorectal cancer [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B114.