Survival of U.S. Black and White patients with squamous cell cancer of the esophagus.

Using data from 11 population-based cancer registries on 1,125 black and 2,392 white patients diagnosed with squamous cell carcinoma of the esophagus in 1992-1998, black-white differences in the relative survival rate (RSR)-which adjusts for mortality in the general population-were large only for localized-stage cancer. Within localized stage, black-white differences in RSR were smaller among patients without pathologic review of regional lymph nodes (RLNs). The low frequency of pathologic review of lymph nodes (8% of blacks and 12% of whites) among patients coded as "localized stage" indicates that staging was based on clinical tests (not recorded in cancer registries) and cancer-directed surgery (which was less frequent in blacks than whites). In Cox proportional hazards regression models, including cancer-directed surgery, along with demographic characteristics, the relative risk of death (hazard ratio) for all blacks versus whites was only 1.13 for all stages but 1.31 in a model with only localized-stage patients. Studies are needed on the extent of radiographic, endoscopic and other techniques used to assess stage in black versus white patients. The low survival rates for both blacks and whites emphasize the need for improved treatment and primary prevention efforts.