Abstract A54: Significant survival improvement of colorectal cancer following surgery from 1997–2004 to 2005–2010 periods in a community hospital in New York City

Abstract

Background: Colorectal cancer is the third most common cancer diagnosed and the second most common cause of cancer death in the United States. For the past two decades, colorectal cancer survival has significantly improved. Although overall colorectal cancer survival has improved, there is limited survival data from inner city patients treated at safety net community hospitals The aim of this study is to analyze post-surgery survival in a community hospital with a high African American (AA) population. Methods: This is a retrospective analysis of prospectively collected data from The Brooklyn Hospital Center's cancer registry, from 1997 to 2010. Of the 1068 registry patients, 275 were excluded leaving 793 (AA n=619, white n=174) for analysis. The study was divided into two time periods: 1997–2004 and 2005–2010. Statistical analyses were performed by SPSS and Epi info software. Chi square and Fisher's exact test, one-way ANOVA analysis are used for the baseline characteristics. Kaplan–Meier survival probabilities are calculated and multivariate Cox proportional hazards models were applied to estimate hazard ratios (HR) with 95% confidence intervals (95% CI). Results: The average age at diagnosis is 67.46±13.23 in 1997–2004 periods and 66.73±12.34 in 2005–2010; there was no significant difference. Significant differences are presented in histological grade as well as pathology stages with high percentage of high grade differential and advanced pathologies in 1997–2004 period and high percentage of low grade differential and early pathology stages in 2005–2010 period with p <0.001 and <0.001 respectively. There is no significant difference in percentage of people who received surgery for these two periods. However, the percentage of people receiving chemotherapy increased in the latter time period. Most common procedure performed was a hemicolectomy. The number of hemicolectomies increased in the later time period (54.2% versus 44.7%, p<0.001). Kaplan Meier survival analysis: post-surgery survival probability significantly improved when comparing 1997–2004 vs 2005–2010 periods (Log-rank p<0.001) with a 5 year survival probability of 55.06% in the 1997–2004 period and 71.2% in the 2005–2010 period. Cox regression hazard ratio is 1.65. This post-surgery survival improvement is not associated with histological grade, site of tumor, but associated with pathology stages and number of lymph nodes removed. Our data demonstrates an improved survival rate in the later time period. This improvement is associated with lower tumor grade differential and early pathologic staging suggesting earlier detection. These data points indicate that minority patients treated in safety net hospitals can achieve superior outcomes. These outcomes are probably related to improvements in patient care delivery and overall cancer awareness. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A54.