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Occult tumor burden contributes to racial disparities in stage-specific colorectal cancer outcomes
Version of Record online: 1 SEP 2011
Copyright © 2011 American Cancer Society
Volume 118, Issue 9, pages 2532–2540, 1 May 2012
How to Cite
Hyslop, T., Weinberg, D. S., Schulz, S., Barkun, A. and Waldman, S. A. (2012), Occult tumor burden contributes to racial disparities in stage-specific colorectal cancer outcomes. Cancer, 118: 2532–2540. doi: 10.1002/cncr.26516
- Issue online: 20 APR 2012
- Version of Record online: 1 SEP 2011
- Manuscript Accepted: 22 JUL 2011
- Manuscript Revised: 21 JUL 2011
- Manuscript Received: 23 JUN 2011
- racial disparities;
- colorectal cancer;
- molecular staging;
- occult tumor burden;
- guanylyl cyclase C;
There are differences in outcomes in blacks compared with whites with lymph node–negative (pN0) colorectal cancer. Recurrence in pN0 patients suggests the presence of occult metastases undetected by conventional approaches. This study explores the association of racial differences in outcomes with occult tumor burden in regional lymph nodes.
Lymph nodes (range, 2-159) from 282 prospectively enrolled pN0 colorectal cancer patients followed for a median of 24 months (range, 2-63 months) were subjected to molecular analysis. Occult tumor burden was estimated by quantifying the expression of GUCY2C, a biomarker for metastatic colorectal cancer cells. Risk categories defined using occult tumor burden was the primary outcome measure. Association of prognostic variables and risk were defined by multivariate polytomous logistic regression.
Occult tumor burden stratified this cohort of 259 whites and 23 blacks into categories with low (60%; recurrence rate [RR] = 2.3%; 95% confidence interval [CI], 0.1%-4.5%), intermediate (31%; RR = 33.3%; 95% CI, 23.7%-44.1%), and high (9%; RR = 68.0%; 95% CI, 46.5%-85.1%; P < .001) risk. Blacks compared with whites exhibited 4-fold greater occult metastases in individual lymph nodes (P < .001). Multivariate analysis revealed that race (P = .02), T stage (P = .02), and number of lymph nodes collected (P = .003) were independent prognostic markers of risk category. Blacks compared with whites were more likely to harbor levels of occult tumor burden, associated with the highest recurrence risk (adjusted odds ratio = 5.08; 95% CI, 1.69-21.39; P = .007).
Racial disparities in stage-specific outcomes in colorectal cancer are associated with differences in occult tumor burden in regional lymph nodes. Cancer 2012. © 2011 American Cancer Society.