Race, prognostic markers and survival in early and late-onset colorectal cancer

描述（由申请人提供）：结直肠癌（CRC）是美国第三大常见恶性肿瘤，也是癌症死亡的第三大原因。与欧洲裔美国人（EA）相比，非洲裔美国人（AA）的CRC死亡率明显更高，这是更高的发病率和更低的生存率的函数。与EA相比，非裔美国人中至少有一些死亡率过高是由于与晚期疾病和诊断时转移性疾病的患病率较高相关的生存率降低所致。然而，即使在控制了诊断阶段后，生存率的种族差异仍然存在。其原因尚不清楚，但可能的解释包括生物因素的种族差异，如原发性和/或转移性肿瘤的侵袭性，以及非生物因素，如社会经济变量和/或治疗相关因素。研究计划的主要目标是调查年龄、病理学和病理形态学标志物的组合作为CRC生存率种族差异的促成因素。我们的中心假设是，种族差异至少部分是由于年轻AA更容易发展为更具侵袭性的CRC，这反过来又导致对治疗的反应较差，因此总生存率较低。我们将进行一项横断面研究，收集肿瘤标本，以提供一个全面和准确的总结，病理，病理形态学特征的原发肿瘤在AA和EA与CRC。接下来，我们将进行一项分析，以检查种族和病理学及病理形态学标记物对AA和EA中早发和迟发CRC生存率的联合影响。这项研究将产生所需的证据，开始解决几个重要的问题，病理指标的作用，影响AA和EA之间的生存差异。本研究的结果将作为一项大规模研究的初步数据，该研究将在整个南卡罗来纳州招募患者。接下来的更大规模的研究将解决一系列问题，包括生物和非生物指标如何影响治疗依从性，治疗反应和总生存率的种族差异。

DESCRIPTION (provided by applicant): Colorectal cancer (CRC) is the 3rd most common malignancy in the US and the third leading cause of cancer death. Compared to European Americans (EA), African Americans (AA) have a substantially higher CRC mortality rate that is a function of both a higher incidence rate and lower survival rate. At least some of the excess mortality in African Americans is caused by the reduced survival associated with a higher prevalence of late stage disease and more metastatic disease at diagnosis compared to EA. However, racial disparities in survival persist even after controlling for stage at diagnosis. The reasons for this are not known, but possible explanations include racial differences in biologic factors, such as the aggressiveness of the primary and/or metastatic tumors, and non-biologic factors such as socioeconomic variables, and or treatment related factors. The primary goal of the research plan is to investigate the combination of age and pathologic and pathomorphologic markers as contributing factors to the racial disparity in CRC survival. Our central hypothesis is that the racial disparity is at least partially driven by younger AA having a greater predispositio to develop more aggressive CRC, which in turn result in poorer response to treatment and hence lower overall survival. We will perform a cross sectional study to collect tumor specimens to provide a comprehensive and accurate summary of the pathologic, pathomorphologic features of primary tumors in AA and EA with CRC. Next, we will perform an analysis to examine the joint influence of race and pathologic and pathomorphologic markers on survival in early and late onset CRC in AA and EA. This study will generate needed evidence to begin to address several important questions regarding the role of pathologic indicators in influencing the differences in survival between AA and EA. The results from the present proposal will serve as preliminary data for a larger-scale study that will enroll patients throughout South Carolina. The larger study to follow will address a suite of questions that will include how biologic and non-biologic indicators impact racial differences in treatment adherence, response to therapy, and overall survival.