FCCC LOGO Faculty Publications
Hyslop T , Weinberg DS , Schulz S , Barkun A , Waldman SA
Occult tumor burden contributes to racial disparities in stage-specific colorectal cancer outcomes
Cancer. 2012 May 1;118(9) :2532-40
PMID: 21887684    PMCID: PMC3235256    URL: https://www.ncbi.nlm.nih.gov/pubmed/21887684
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BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: Racial disparities in stage-specific outcomes in colorectal cancer are associated with differences in occult tumor burden in regional lymph nodes.
Hyslop, Terry Weinberg, David S Schulz, Stephanie Barkun, Alan Waldman, Scott A eng R21 CA112147/CA/NCI NIH HHS/ CA146033/CA/NCI NIH HHS/ CA75123/CA/NCI NIH HHS/ R01 CA075123-07/CA/NCI NIH HHS/ R33 CA112147-04/CA/NCI NIH HHS/ R01 CA095026/CA/NCI NIH HHS/ CA95026/CA/NCI NIH HHS/ RC1 CA146033-02/CA/NCI NIH HHS/ R01 CA075123/CA/NCI NIH HHS/ R01 CA095026-06/CA/NCI NIH HHS/ CA112147/CA/NCI NIH HHS/ R33 CA112147/CA/NCI NIH HHS/ RC1 CA146033/CA/NCI NIH HHS/ Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, Non-P.H.S. Cancer. 2012 May 1;118(9):2532-40. doi: 10.1002/cncr.26516. Epub 2011 Sep 1.