TY - JOUR
T1 - Outcomes among black patients with stage II and III colon cancer receiving chemotherapy
T2 - An analysis of ACCENT adjuvant trials
AU - Yothers, Greg
AU - Sargent, Daniel J.
AU - Wolmark, Norman
AU - Goldberg, Richard M.
AU - O'Connell, Michael J.
AU - Benedetti, Jacqueline K.
AU - Saltz, Leonard B.
AU - Dignam, James J.
AU - Blackstock, A. William
N1 - Funding Information:
Conflicts of interest: NW declares funding from sanofi-aventis to NSABP through a business contract for C-07 only, for certain costs not covered by the NCI, for non-standard-of-care procedures required for the study. Also, consultancy from sanofi-aventis (C-07 only), honoraria to the NSABP for NW’s participation on the advisory board, and reasonable travel and accommodations for the sanofi-aventis board meeting. There are no other potential conflicts.
PY - 2011/10/19
Y1 - 2011/10/19
N2 - Conclusion Background Among patients with resected colon cancer, black patients have worse survival than whites. We investigated whether disparities in survival and related endpoints would persist when patients were treated with identical therapies in controlled clinical trials.Conclusion Methods We assessed 14611 patients (1218 black and 13393 white) who received standardized adjuvant treatment in 12 randomized controlled clinical trials conducted in North America for resected stage II and stage III colon cancer between 1977 and 2002. Individual patient data on covariates and outcomes were extracted from the Adjuvant Colon Cancer ENdpoinTs (ACCENT) database. The endpoints examined in this meta-analysis were overall survival (time to death), recurrence-free survival (time to recurrence or death), and recurrence-free interval (time to recurrence). Cox models were stratified by study and controlled for sex, stage, age, and treatment to determine the effect of race. Kaplan-Meier estimates were adjusted for similar covariates to control for confounding. All statistical tests were two-sided.Conclusion Results Black patients were younger than whites (median age, 58 vs 61 years, respectively; P <. 001) and more likely to be female (55% vs 45%, respectively; P <. 001). Overall survival was worse in black patients than whites (hazard ratio [HR] of death = 1.22, 95% confidence interval [CI] = 1.11 to 1.34, P <. 001). Five-year overall survival rates for blacks and whites were 68.2% and 72.8%, respectively. When subsets defined by sex, stage, and age were analyzed, overall survival was consistently worse in black patients. Recurrence-free survival was worse in black patients than whites (HR of recurrence or death = 1.14, 95% CI = 1.04 to 1.24, P =. 0045). Three-year recurrence-free survival rates in blacks and whites were 68.4% and 72.1%, respectively. In contrast, recurrence-free interval was similar in black and white patients (HR of recurrence = 1.08, 95% CI = 0.97 to 1.19, P =. 15). Three-year recurrence-free interval rates in blacks and whites were 71.3% and 74.2%, respectively.Conclusion Conclusion sBlack patients with resected stage II and stage III colon cancer who were treated with the same therapy as white patients experienced worse overall and recurrence-free survival, but similar recurrence-free interval, compared with white patients. The differences in survival may be mostly because of factors unrelated to the patients' adjuvant colon cancer treatment.
AB - Conclusion Background Among patients with resected colon cancer, black patients have worse survival than whites. We investigated whether disparities in survival and related endpoints would persist when patients were treated with identical therapies in controlled clinical trials.Conclusion Methods We assessed 14611 patients (1218 black and 13393 white) who received standardized adjuvant treatment in 12 randomized controlled clinical trials conducted in North America for resected stage II and stage III colon cancer between 1977 and 2002. Individual patient data on covariates and outcomes were extracted from the Adjuvant Colon Cancer ENdpoinTs (ACCENT) database. The endpoints examined in this meta-analysis were overall survival (time to death), recurrence-free survival (time to recurrence or death), and recurrence-free interval (time to recurrence). Cox models were stratified by study and controlled for sex, stage, age, and treatment to determine the effect of race. Kaplan-Meier estimates were adjusted for similar covariates to control for confounding. All statistical tests were two-sided.Conclusion Results Black patients were younger than whites (median age, 58 vs 61 years, respectively; P <. 001) and more likely to be female (55% vs 45%, respectively; P <. 001). Overall survival was worse in black patients than whites (hazard ratio [HR] of death = 1.22, 95% confidence interval [CI] = 1.11 to 1.34, P <. 001). Five-year overall survival rates for blacks and whites were 68.2% and 72.8%, respectively. When subsets defined by sex, stage, and age were analyzed, overall survival was consistently worse in black patients. Recurrence-free survival was worse in black patients than whites (HR of recurrence or death = 1.14, 95% CI = 1.04 to 1.24, P =. 0045). Three-year recurrence-free survival rates in blacks and whites were 68.4% and 72.1%, respectively. In contrast, recurrence-free interval was similar in black and white patients (HR of recurrence = 1.08, 95% CI = 0.97 to 1.19, P =. 15). Three-year recurrence-free interval rates in blacks and whites were 71.3% and 74.2%, respectively.Conclusion Conclusion sBlack patients with resected stage II and stage III colon cancer who were treated with the same therapy as white patients experienced worse overall and recurrence-free survival, but similar recurrence-free interval, compared with white patients. The differences in survival may be mostly because of factors unrelated to the patients' adjuvant colon cancer treatment.
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U2 - 10.1093/jnci/djr310
DO - 10.1093/jnci/djr310
M3 - Article
C2 - 21997132
AN - SCOPUS:80054941039
SN - 0027-8874
VL - 103
SP - 1498
EP - 1506
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 20
ER -