518 – Racial Disparities in Rates of Surgery for Esophageal Cancer: A Study from the National Cancer Database

Purpose: The National Comprehensive Cancer Network (NCCN) and Society of Thoracic Surgeons guidelines for stage I-III esophageal cancer indicate that management should include surgical intervention when possible.Given these clear recommendations, we sought to determine if there is a disparity in treatment regimens between white and black patients in this population.Methods: We queried the National Cancer Database (NCDB) Participant User File for stage I-III esophageal adenocarcinoma (AC) and squamous cell carcinoma (SCC) patients diagnosed between 2004 and 2015.Analysis of black versus white patients was performed separately on six patient subsets based on stage and histology (see Table 1).Descriptive analyses of patient demographics, treatment regimens, and survival were S-103 AGA Abstracts performed.Univariate and multivariate analyses were used to identify factors associated with receiving surgical interventions.All analyses were then repeated on matched patient cohorts, which were created using a coarsened exact matching algorithm to reduce confounding.A p-value <0.05 was considered significant.Results: We identified 69,672 patients who met the inclusion criteria.Of these, 46,783 had AC (927 black; 45,856 white) and 22,889 had SCC (5,441 black; 17,448 white).After 1:1 matching, there were 1,586 AC and 7,290 SCC patients.For all disease subsets, the aggregate analysis demonstrated that significantly fewer black than white patients received surgery.Additionally, multivariate analysis revealed that black race independently conferred a lower likelihood of receiving surgery compared to white patients (odds ratios ranged from 0.45 -0.69).Furthermore, regardless of stage or histology, overall survival (OS) was significantly shorter for black patients than for white patients, as well as for patients who did not receive surgery.These findings remained significant for most of the patient subsets upon matching (Table 1; Figure 1).Conclusion: Despite well-defined management guidelines, there is a clear gap between black and white patients with regard to the rate and likelihood of surgical intervention for esophageal cancer in NCDB.Given the shorter OS associated with not receiving surgery, this highlights the need for improved education of patients and providers.