Overall survival is significantly lower among Black patients with colorectal liver metastases compared with white patients, according to study results published in JAMA Network Open.

Investigators found that Black patients were much less likely to undergo chemotherapy or surgical resection than their white comparators. However, Black and White patients who underwent liver resection for colorectal liver metastases had comparable survival rates, suggesting that liver resection may be an essential way to eliminate racial disparities in metastasis survival.

Previous studies have found that Black patients have significantly lower rates of survival after surgery for colorectal cancer in the United States. However, differential survival rates among patients with metastatic colorectal cancer remains unclear. Investigators extracted data from the California Cancer Registry to assess whether racial disparities persist in patients with colorectal liver metastases. Survival was defined as amount of time elapsed from metastatic diagnosis. Cox proportional hazard models were used to estimate the risk of death across patient groups. Analyses were stratified by liver resection and adjusted for demographic and clinical covariates.


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The study cohort included 16,382 patients (53% men). Black patients had the lowest median survival after diagnosis (11 months) compared with Asian (14 months), Hispanic (14 months), Middle Eastern (18 months), and White (12 months) patients. Compared with White and Hispanic patients, Black patients were less likely to undergo chemotherapy (59% vs 65% [White] vs 68% [Hispanic]; P <.001) or liver resection (6.2% vs 10.3% [White] vs 9.5% [Hispanic]; P <.001). In hazard models adjusted for age, sex, comorbidities, and extrahepatic metastasis, Black patients were significantly more likely to die than White patients (hazard ratio [HR], 1.17; 95% CI, 1.10-1.24; P <.001). However, among patients who underwent liver resection, no race-based disparities in survival were noted (P =.84 for Black vs white patients).

While Black patients had lower overall survival compared to patients of other races, these discrepancies disappeared when liver resection was performed. Access to surgical resection appears to be key in increasing survival after colorectal liver metastases diagnosis.

As a study limitation, investigators noted that hospital characteristics were not factored into analyses. Hospitals more focused on chemotherapy vs liver resection likely have different survival rates. Additionally, analyses were not adjusted for surgeon-assessed “resectability” of colorectal liver metastases; patients who underwent resection may have had less severe metastases to begin with.

Even so, “These data may provide a basis for a future quality benchmark that all patients with [colorectal liver metastases] should be evaluated for resection by a liver surgeon in the office or tumor board setting,” investigators concluded.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Thornblade LW, Warner S, Melstrom L, Singh G, Fong Y, Raoof M. Association of race/ethnicity with overall survival among patients with colorectal liver metastasis. JAMA Netw Open. 2020;3(9):e2016019.