Race and Ethnicity Impacts Overall Survival of Patients with Appendiceal Cancer Who Undergo Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

SIMPLE SUMMARY: The influence of race/ethnicity on overall survival in patients with appendiceal cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is unknown. In this first large-scale study, we demonstrate that patient race/ethnicity plays a role in overall survival in this patient population. Striking differences in patient sociodemographics, including patient age, sex, income, education, and geographic location, may contribute to these disparities. However, no differences in patient perioperative and postoperative outcomes were found (e.g., tumor grade, margins, hospital length of stay, readmission rates, and 30/90-day mortality). Despite this, when compared by race/ethnicity, patients of non-Hispanic Black descent had worse overall survival rates than patients of Hispanic descent. Non-Hispanic White individuals had similar overall survival rates to non-Hispanic Black individuals. Further inquiry is warranted to determine why this survival disparity is present amongst diverse patient groups afflicted with this disease. ABSTRACT: Appendiceal cancer treatment may include cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). We investigated whether patient race/ethnicity influences outcomes and overall survival for patients with appendiceal cancer who undergo CRS/HIPEC. We queried the National Cancer Database for adult patients with appendiceal cancer treated with CRS/HIPEC from 2006 to 2018. Patients were stratified by race/ethnicity: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, and Other. Sociodemographics and outcomes were compared using descriptive statistics. Kaplan–Meier survival analysis and Log-rank tests assessed differences in overall survival (OS). Cox Multivariate Regression evaluated factors associated with OS. In total, 2532 patients were identified: 2098 (82.9%) NHW, 186 (7.3%) NHB, 127 (5.0%) Hispanic, and 121 (4.8%) Other patients. The sociodemographics were statistically different across groups. The perioperative and postoperative outcomes were similar. OS was significantly different by race/ethnicity (p = 0.0029). NHB patients compared to Hispanic patients had the shortest median OS (106.7 vs. 145.9 months, p = 0.0093). Race/ethnicity was independently associated with OS: NHB (HR: 2.117 [1.306, 3.431], p = 0.0023) and NHW (HR: 1.549 [1.007, 2.383], p = 0.0463) patients compared to Hispanic patients had worse survival rates. Racial/ethnic disparities exist for patients with appendiceal cancer undergoing CRS/HIPEC. Despite having similar tumor and treatment characteristics, OS is associated with patient race/ethnicity.