The results obtained from these three indices were strikingly similar. For patients with severe comorbidity, all three indices were statistically significant in predicting shorter survival after surgery for colon cancer.

BACKGROUND Studies of colorectal adenocarcinoma (CRC) indicate a higher mortality rate for African Americans compared with Caucasians in the United States. In the current study, the authors evaluated the racial differences in survival based on tumor location and pathologic stage between African‐American patients and Caucasian patients who underwent surgery alone for CRC. METHODS All 199 African American patients and 292 randomly selected, non‐Hispanic Caucasian patients who underwent surgery between 1981 and 1993 for first primary sporadic CRC at the University of Alabama–Birmingham (Birmingham, AL) or an affiliated Veterans Affairs hospital were assessed for differences in survival. None of these patients received preoperative or postoperative neoadjuvant or adjuvant therapy. Survival curves were generated using the Kaplan–Meier method, and hazard ratios with 95% confidence intervals (95% CI) were estimated from Cox proportional hazards models, adjusting for demographic and tumor characteristics. RESULTS African Americans were 1.67 (95% CI, 1.21–2.33) and 1.52 (95% CI, 1.12–2.07) times more likely to die of colonic adenocarcinoma (CAC) within 5 years and 10 years of surgery, respectively, compared with Caucasians. Racial differences in survival were observed among patients with Stage II, III, and IV CAC; however, the strongest and statistically significant association was observed among patients with Stage II CAC. There were no significant racial differences in survival in patients with rectal adenocarcinomas. CONCLUSIONS The current findings suggest that the decreased overall survival at 5 years and 10 years postsurgery observed in African‐American patients with CAC may not be attributable to tumor stage at diagnosis or treatment but may be due to differences in other biologic or genetic characteristics between African‐American patients and Caucasian patients. Cancer 2004. © 2004 American Cancer Society

BACKGROUND-To identify the factors that contribute to poorer colon carcinoma survival rates for African Americans compared with Caucasians, the authors evaluated survival differences based on the histologic grade (differentiation) of the tumor. METHODS-All 169 African Americans and 229 randomly selected non-Hispanic Caucasians who underwent surgery during 1981-1993 for first primary sporadic colon carcinoma at the University of Alabama at Birmingham or its affiliated Veterans Affairs hospital were included in the current study. None of these patients received presurgery or postsurgery therapies. Recently, the authors reported an increased risk of colon carcinoma death for African Americans in this patient population, after adjustment for stage and other clinicodemographic features. The authors generated Kaplan-Meier survival probabilities according to race and tumor differentiation and multivariate Cox proportional hazards models to estimate hazard ratios (HR) with 95% confidence intervals (95% CI). RESULTS-There were no differences in the distribution of pathologic tumor stage between racial groups after stratifying by histologic tumor grade. Among patients with high-grade tumors, 54% of African Americans and 21% of Caucasians died within the first year after surgery (P = 0.007). African Americans with high-grade tumors were 3 times (HR = 3.05; 95% CI, 1.32-7.05) more likely to die of colon carcinoma within 5 years postsurgery, compared with Caucasians with high-grade tumors. There were no survival differences by race among patients with low-grade tumors. CONCLUSIONS-These findings suggested that poorer survival among African-American patients with adenocarcinomas of the colon may not be attributable to an advanced pathologic stage of disease at diagnosis, but instead may be due to aggressive biologic features like high tumor grades. Keywords African Americans; Caucasians; colon carcinoma; high-grade tumor differentiation Colorectal carcinoma (CRC) is the third most common malignancy and second most common cause of cancer mortality among men and women in the United States. In 2004, it is estimated that there will have been 106,370 new cases of colon carcinoma and 40,570 new cases of rectal carcinoma with 56,730 deaths due to colon and rectal carcinoma combined. 1 In the United States, there are racial differences (African American compared with Caucasian

Purpose: Although the decreased expression of p27 kip-1 , a cyclin-dependent kinase inhibitor, has been correlated with advanced tumor stage and short survival of patients with colorectal adenocarcinomas (CRCs), its prognostic value based on the tumor site, tumor stage, and patient ethnicity was not assessed. Therefore, in this study, we investigated whether the prognostic value of p27 kip-1 expression varies with the tumor site, tumor stage and patient ethnicity.Experimental Design: We evaluated 206 (85 African Americans and 121 Caucasians) archival tissue specimens of first primary CRCs for immunohistochemical expression of p27 kip-1 , and its prognostic significance was analyzed using univariate Kaplan-Meier and multivariate Cox regression survival methods.Results: Although, similar proportion of CRCs with decreased p27 kip-1 expression was observed in all stages (range, 26 -36%), the decreased p27 kip-1 expression has been shown as a marker of poor prognosis only for patients with stage III tumors both in univariate (log-rank test, P ‫؍‬ 0.014) and multivariate (hazard ratio ‫؍‬ 3.2, 95% confidence interval ‫؍‬ 1.3-7.7; P ‫؍‬ 0.01) survival analyses. The decreased expression of p27 kip-1 was associated with a high histologic grade (P ‫؍‬ 0.016) in stage II CRCs, and with distal tumors (P ‫؍‬ 0.001), tumor invasion (P ‫؍‬ 0.044), and with local recurrence (P ‫؍‬ 0.008) in stage III CRCs.Conclusions: No prognostic significance was found for p27 kip-1 expression in stages I, II, or IV CRCs, and its prognostic value was not associated with either ethnicity or tumor location. These studies suggest that decreased expression of p27 kip-1 is an indicator of poor prognosis and aids in identifying a subset of patients with aggressive forms of stage III CRCs.