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

简介(申请人提供)：结直肠癌(CRC)是美国第三种最常见的恶性肿瘤，也是导致癌症死亡的第三大原因。与欧洲裔美国人(EA)相比，非裔美国人(AA)的结直肠癌死亡率显著高于欧洲裔美国人，这是高发病率和低存活率的函数。与EA相比，非洲裔美国人的超额死亡率至少有一部分是由于与晚期疾病的高患病率和更多的转移性疾病相关的存活率降低所致。然而，即使在诊断时控制了阶段后，存活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，如原发和/或转移肿瘤的侵袭性，以及非生物因素，如社会经济变量，和/或治疗相关因素。该研究计划的主要目标是调查年龄、病理和病理形态标志的组合作为影响结直肠癌存活率的种族差异的因素。我们的中心假设是，种族差异至少部分是由年轻的再障患者更容易患上更具侵袭性的结直肠癌，这反过来导致对治疗的反应较差，从而降低总体存活率。我们将进行横断面研究，以收集肿瘤标本，以全面和准确地总结AA和EA合并结直肠癌的原发肿瘤的病理、病理形态特征。接下来，我们将进行一项分析，以检验在AA和EA中，种族与病理和病理形态标志对早发和晚发结直肠癌患者生存率的联合影响。这项研究将产生必要的证据，以开始解决几个重要的问题，即病理指标在影响AA和EA之间存活率差异中的作用。本提案的结果将作为一项更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、治疗反应和总体存活率的种族差异。 公共卫生相关性：结直肠癌是发病率和死亡率的重要来源，尤其是在非裔美国人中。像这项提议的研究一样，试图了解结直肠癌种族差异的原因，从而为疾病过程的机制提供见解。我们设想本提案是探索、了解和改善AA诊断为结直肠癌患者预后的更大问题的一部分。

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. PUBLIC HEALTH RELEVANCE: Colorectal cancer is the source of significant morbidity and mortality especially among African Americans. Studies, like the one proposed, seek to understand the reasons for racial disparities in colorectal cancer and hence provide insights into the mechanisms of the disease process. We envision the present proposal as part of the larger question of exploring, understanding, and improving outcomes among AA diagnosed with colorectal cancer.