title: Outcomes among black patients with stage II and III colon cancer receiving chemotherapy: an analysis of ACCENT adjuvant trials.
abstract: 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.
  
  
  METHODS
  We assessed 14,611 patients (1218 black and 13,393 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.
  
  
  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.
  
  
  CONCLUSIONS
  Black 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.
authors: National Surgical Adjuvant Breast and Bowel Project Biostatistical Center, One Sterling Plaza, 201 N Craig St, Pittsburgh, PA 15213, USA. yothers@nsabp.pitt.edu
authors: Greg
authors: G
authors: Yothers
authors: Daniel J
authors: DJ
authors: Sargent
authors: Norman
authors: N
authors: Wolmark
authors: Richard M
authors: RM
authors: Goldberg
authors: Michael J
authors: MJ
authors: O'Connell
authors: Jacqueline K
authors: JK
authors: Benedetti
authors: Leonard B
authors: LB
authors: Saltz
authors: James J
authors: JJ
authors: Dignam
authors: A William
authors: AW
authors: Blackstock
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D003110:Colonic Neoplasms / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015986:Confounding Factors, Epidemiologic; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D002955:Leucovorin / Q000008:administration & dosage; D007978:Levamisole / Q000008:administration & dosage; D008130:Lomustine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014750:Vincristine / Q000008:administration & dosage; D044465:White People / Q000706:statistics & numerical data
chemical_list: D007978:Levamisole; D014750:Vincristine; D008130:Lomustine; D002955:Leucovorin; D005472:Fluorouracil