title: Impact of sex, age, and ethnicity/race on the survival of patients with rectal cancer in the United States from 1988 to 2012.
abstract: Most studies report on colon and rectal cancers collectively, even though biologic and prognostic differences exist between these disease entities. Here, we investigated the effects of sex, age, and ethnicity/race on rectal cancer (RC) mortality by stage focusing on differences before and after 2004.Using the SEER database, we identified 105,511 patients diagnosed with RC from 1988-2012. Main outcomes were disease-specific survival (DSS) and overall survival (OS).In patients with stage I-III RC, women achieved a longer DSS (HR 0.87, P < 0.001) than men, independent of age, from 1988-2012. In stage IV disease, the sex disparity favoring women was limited to the age 18-44 yr cohort (DSS HR 0.79, P < 0.001). The sex difference in DSS (Pinteraction = 0.009) was significantly reduced from 2004 to 2012 across all ages. Hispanics and Native Americans with locoregional RC had inferior DSS relative to Whites from 1988-2003, but these differences were not evident from 2004-2012 (Pinteraction = 0.001). Additionally, Asians with stage I-III RC had superior DSS from 2004 on compared to Whites. Mortality in African American patients improved modestly overall and remained significantly higher than other ethnicities/races across all stages.Sex disparities have narrowed in patients with metastatic RC, but persist in patients with stage I-III disease. These differences are most evident among young patients (18-44 years), where sex disparities have even widened in stage I-III disease. While outcomes have improved for Asians, Hispanics, and Native Americans with stage I-III rectal cancer, black-white disparities remain in all disease stages.
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Berger
authors.affiliation: Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Dongyun
authors.initials: D
authors.lastname: Yang
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Yu
authors.initials: Y
authors.lastname: Sunakawa
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Wu
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Ning
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsusaka
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okazaki
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miyamoto
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Mitsukuni
authors.initials: M
authors.lastname: Suenaga
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Marta
authors.initials: M
authors.lastname: Schirripa
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Annika Medea
authors.initials: AM
authors.lastname: Lenz
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bohanes
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Afsaneh
authors.initials: A
authors.lastname: Barzi
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.|Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Figueiredo
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Hanna
authors.affiliation: Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.|Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Heinz-Josef
authors.initials: HJ
authors.lastname: Lenz
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000208:ethnology* / Q000401:mortality*; D018426:SEER Program; D012727:Sex Characteristics; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: age; ethnicity/race; rectal cancer; sex; survival