Journal of gastrointestinal cancer · 2025
Sociodemographic Determinants Associated with the Receipt of Adjuvant Chemotherapy in Stage III Colorectal Cancer: A Population-Based Study from the SEER Registry.
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Emile Sameh Hany, Horesh Nir, Garoufalia Zoe, Wignakumar Anjelli, Boutros Marylise, Wexner Steven D
Аннотация
BACKGROUND: Approximately 35% of patients do not receive adjuvant chemotherapy (AC) after surgery for stage III colorectal cancer (CRC). We aimed to investigate the association between receipt of AC and sociodemographic and treatment factors.
METHODS: A retrospective case-control analysis of patients with stage III CRC who underwent radical resection was performed using data from the SEER registry (2010-2020). The main exposure was socioeconomic determinants, and the main outcome was receipt of AC. Multivariable binary logistic regression analyses were used to assess independent predictors of AC receipt.
RESULTS: A total of 81,720 patients (52.4% male; median age, 65 years) were included. Overall, 70.6% of tumors were colonic and 29.4% rectal. 41.7% of patients did not receive AC. Independent socioeconomic determinants of AC receipt were age < 50 years (OR: 2.36, p < 0.001), male sex (OR: 0.931, p = 0.002), Black race (OR: 1.12, p = 0.002), Hispanic ethnicity (OR: 1.13, p < 0.001), household income <$50,000 (OR: 1.16, p = 0.001), non-metropolitan residence (OR: 1.09, p = 0.035), and unmarried status (single-OR: 0.778, p < 0.001, divorced-OR: 0.87, p < 0.001, widowed-OR: 0.313, p < 0.001). Tumor characteristics associated with AC receipt included tumor location and size, perineural invasion, number of positive lymph nodes, and CEA levels. Neoadjuvant chemotherapy (OR: 0.37, 95%CI: 0.28-0.48) and neoadjuvant radiation therapy (OR: 0.42, 95%CI: 0.38-0.46) were associated with lower odds of receiving AC in patients with colon and rectal cancer, respectively.
CONCLUSIONS: Receipt of AC was less likely among elderly males and those who received neoadjuvant treatments. Black and Hispanic patients and patients with low household income were more likely to receive AC.
METHODS: A retrospective case-control analysis of patients with stage III CRC who underwent radical resection was performed using data from the SEER registry (2010-2020). The main exposure was socioeconomic determinants, and the main outcome was receipt of AC. Multivariable binary logistic regression analyses were used to assess independent predictors of AC receipt.
RESULTS: A total of 81,720 patients (52.4% male; median age, 65 years) were included. Overall, 70.6% of tumors were colonic and 29.4% rectal. 41.7% of patients did not receive AC. Independent socioeconomic determinants of AC receipt were age < 50 years (OR: 2.36, p < 0.001), male sex (OR: 0.931, p = 0.002), Black race (OR: 1.12, p = 0.002), Hispanic ethnicity (OR: 1.13, p < 0.001), household income <$50,000 (OR: 1.16, p = 0.001), non-metropolitan residence (OR: 1.09, p = 0.035), and unmarried status (single-OR: 0.778, p < 0.001, divorced-OR: 0.87, p < 0.001, widowed-OR: 0.313, p < 0.001). Tumor characteristics associated with AC receipt included tumor location and size, perineural invasion, number of positive lymph nodes, and CEA levels. Neoadjuvant chemotherapy (OR: 0.37, 95%CI: 0.28-0.48) and neoadjuvant radiation therapy (OR: 0.42, 95%CI: 0.38-0.46) were associated with lower odds of receiving AC in patients with colon and rectal cancer, respectively.
CONCLUSIONS: Receipt of AC was less likely among elderly males and those who received neoadjuvant treatments. Black and Hispanic patients and patients with low household income were more likely to receive AC.