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）是美国第三大最常见的恶性肿瘤，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死亡率要高得多，这是高发病率和低存活率的共同作用。至少部分非裔美国人的高死亡率是由于与EA相比，晚期疾病和诊断时转移性疾病的较高患病率导致的生存率降低。然而，即使在控制了诊断时的阶段后，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研究年龄、病理和病理形态学标志物的结合，作为结直肠癌生存中种族差异的影响因素。我们的中心假设是，种族差异至少部分是由年轻的AA更容易发展为更具侵袭性的CRC所驱动的，这反过来导致对治疗的反应更差，因此总体生存率更低。我们将进行横断面研究，收集肿瘤标本，以全面准确地总结AA和EA合并结直肠癌原发肿瘤的病理、病理形态学特征。接下来,我们将执行一个分析检查联合种族和病理和pathomorphologic标记对生存的影响在早期和晚期发病CRC AA和EA。本研究将生成所需的证据开始解决一些重要的问题关于病理指标的作用影响的差异之间的生存AA和EA。目前建议的结果将作为一个大规模的研究初步数据将在南中登记的病人卡罗莱纳。接下来的大型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、治疗反应和总体生存率方面的种族差异。

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.