Survival Disparities in Adenocarcinoma Within Adenomatous Polyps: A National Cancer Database Analysis

Purpose Adenocarcinoma within adenomatous polyps is a rare malignancy characterized by outward growths from the lining of the colon or rectum. These neoplasms can develop over several years, with only a small proportion of adenomatous polyps demonstrating malignant potential. Information and treatment options are limited due to the rarity of this cancer. This retrospective cohort study aims to identify and analyze demographic and prognostic factors associated with overall survival and mortality in patients diagnosed with adenocarcinoma within adenomatous polyps. Methods Patients diagnosed with adenocarcinoma within adenomatous polyps between 2004 and 2020 were identified using the histology code 8210 through the National Cancer Database (NCDB). Kaplan-Meier curves, multivariable Cox proportional hazards regression analyses, and locally estimated scatterplot smoothing (LOESS) were utilized to assess whether there are statistically significant relationships between demographic and prognostic factors and survival in patients diagnosed with adenocarcinoma within adenomatous polyps. Results A cohort of 58,643 patients with adenocarcinoma within adenomatous polyps was analyzed to identify factors influencing survival. Older age was associated with poorer overall survival, with 5-year and 10-year survival rates of 52% (n = 7,864) and 25% (n = 3,750), respectively, in patients aged 76-100 years. Females exhibited better survival outcomes, with 5-year and 10-year survival rates of 74% (n = 20,439) and 57% (n = 15,626), compared to males (5-year: 71%, n = 22,031; 10-year: 53%, n = 16,485). The Black race had a 69% increased mortality risk compared to other races (hazard ratio (HR) = 0.69; 95% confidence interval (CI): 0.64-0.75, p < 0.001). Patients with a Charlson-Deyo (CD) comorbidity score of 1 (HR = 1.30; 95% CI: 1.26-1.34, p < 0.001) and 2 (HR = 1.69; 95% CI: 1.62-1.77, p < 0.001) had higher mortality risks, with a 30% and 69% increased risk, respectively, compared to those with a score of 0. Medicare (HR = 1.25; 95% CI: 1.20-1.29, p < 0.001) and Medicaid (HR = 1.67; 95% CI: 1.55-1.79, p < 0.001) insurance were also associated with decreased survival. Survival probability declined with advanced cancer stage, with Stage IV patients experiencing a 10-fold increased mortality risk compared to Stage I (HR = 10.41; 95% CI: 9.91-10.94, p < 0.001). Conclusions Older age, male sex, Black race, Medicare/Medicaid insurance, higher CD score, advanced cancer stage, lower education status, and lower income were all associated with poorer survival outcomes.