EP583 - Demographic Disparities in Salvage Surgery for Patients with Rectal Squamous Cell Carcinoma Outcomes

Sunday, May 11, 2025

4:06 PM – 4:11 PM PT

Location: Monitor 6, Sails Pavilion, Upper Level

ePoster Presenter(s)

JZ

Jacob Zarkower, MPH

Medical Student
George Washington School of Medicine and Health Sciences
Washington, District of Columbia, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Randilu Amarasinghe (she/her/hers)

Medical Student
George Washington University School of Medicine and Health Sciences
Washington DC, DC, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
HS

Hannaka Spillman, MA

Medical Student
George Washington School of Medicine and Health Sciences
Washington, District of Columbia, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Christina Schott, n/a (she/her/hers)

Medical Student
George Washington University School of Medicine and Health Sciences
George Washington University School of Medicine and Health Sciences
Washington, District of Columbia, United States

Disclosure information not submitted.
Meagan K. Mitchell (she/her/hers)

Medical Student
George Washington Univeristy School of Medicine and Health Sciences
Washington, DC, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
NV

Nicholas Van Dyke, n/a

Medical Student
The George Washington University
Washington, District of Columbia, United States

Disclosure information not submitted.
AI

Aisha Inuwa, MD

Resident
George Washington University
Washington, District of Columbia, United States

Disclosure information not submitted.
MN

Matthew Ng, MD

Assistant Professor of Surgery
Fellow
Washington, District of Columbia, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

MK

Marian Khalili, MD

Assistant Professor
MFA
Washington, District of Columbia, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Jacob Zarkower, MPH: This individual has no financial relationships with ineligible companies.

Randilu Amarasinghe: This individual has no financial relationships with ineligible companies.

Hannaka Spillman, MA: This individual has no financial relationships with ineligible companies.

Meagan K. Mitchell: This individual has no financial relationships with ineligible companies.

Matthew Ng, MD: This individual has no financial relationships with ineligible companies.

Marian Khalili, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Cancer patients achieve disparate outcomes based on demographic factors including race, sex, and age. The first-line treatment of rectal squamous cell cancer (SCC) is chemoradiation. Salvage abdominoperineal resection is reserved for patients who fail chemoradiation or patients with disease recurrence following response to chemoradiation. In this study, we aim to identify demographic disparities amongst patients requiring salvage surgery for the treatment of rectal squamous cell cancer.

Methods/Interventions: Adult patients with rectal SCC in the National Cancer Database 2004-2020 were analyzed. Univariable and multivariable logistic regressions were used to evaluate the relationship between race, sex, age, Charlson-Deyo Index score, and likelihood of failed chemoradiation resulting in surgical intervention. Analyses were adjusted for these covariables. Subjects with non-invasive SCC and those with missing values were excluded. Kaplan-Meier survival analysis demonstrated length of survival across race, sex, and surgery versus no-surgery groups.

Results/Outcomes: Among 5,672 patients, 575 had salvage therapy. These patients were younger, male, and on average, had lower Charlson-Deyo Index score. Overall, among all patients with rectal SCC, the there was increased likelihood of death at last contact in black patients compared to white patients (OR 1.36, 95% CI 1.13-1.63), in males compared to females (OR 1.89, 95% CI 1.68-2.13), and in patients with a Charlson-Deyo Index Score of 3 compared to patients with a score of 0 (OR 2.39, 95% CI 1.79-3.19). Kaplan-Meier survival analysis showed the median time-to-death is 6.35 years for white patients compared to 3.43 years for black patients, 8.17 years for females compared to 2.57 years for males, and 6.24 years for patients who received surgery compared to 5.85 for patients who did not receive surgery. Among patients who received salvage surgery for rectal squamous cell cancer, the analysis showed increased likelihood of death at last contact in males compared to females (OR 1.69, 95% CI 1.17-2.43). Kaplan-Meier survival analysis for patients receiving salvage surgery showed the median time-to-death is 6.41 years for white patients compared to 4.18 years for black patients.

Conclusion/Discussion: In this study, younger men were more likely to receive salvage surgery following failed chemoradiation. Black patients had shorter median time-to-death compared to white patients. Further research is necessary to identify and address the causes of the stark disparity in mortality across race and sex groups.