The impact of race and socioeconomic status on stage IV colorectal cancer survival

Published:December 23, 2022DOI:


      • Black patients have worse 5-year overall survival when compared to white patients in stage IV colorectal cancer.
      • Patients who have chemotherapy for stage IV CRC have significantly better survival than in patients who do not get chemotherapy.
      • Colon cancer had significantly worse survival than rectal cancer. Black patients had significantly higher comparative rate of colon cancer.



      The aims of this study were to determine the impact of race and socioeconomics on survival in patients with stage IV colorectal cancer.


      A prospective database of stage IV colorectal cancer patients treated at a multi-hospital health system from 2015 to 2019 was retrospectively analyzed. Univariate and multivariate survival analysis using log-rank Mantel-Cox test and Cox proportional hazard model were performed to determine the impact of race, socioeconomic factors, presentation, and treatment on overall survival.


      4012 patients were diagnosed with colorectal cancer, of which 803 patients were stage IV. There were 677 (84.3%) White, and 108 (13.4%) Black patients. Black patients have worse 5-year overall survival than white patients (HR 1.43 (1.09–1.87)). Patients who received chemotherapy had significantly better survival than patients who did not receive chemotherapy (HR 0.58 (0.47–0.71)). Black patients have significantly lower rates of receiving chemotherapy as compared to white patients (61.1% vs 75.37%, p = 0.0018).


      Patients with Stage IV colorectal cancer have worse survival if they are black, older age, and did not receive chemotherapy.
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