S594 Disparities in Colorectal Cancer Demographics, Mortality, and Survival: A SEER-Based Comparison of East Texas and the Rest of Texas (2017–2021)

Introduction: Colorectal cancer (CRC) outcomes vary by geography, race, and clinical features. East Texas, a medically underserved region, may experience disparities in presentation, treatment, and survival. Using population-based data, we aimed to describe and compare CRC characteristics, mortality, and survival between East Texas and the rest of Texas. Methods: We conducted a descriptive analysis of CRC cases in Texas from 2017 to 2021 using the Surveillance, Epidemiology, and End Results (SEER) registry. Patients were grouped as East Texas versus Texas, excluding East Texas. We assessed demographics, tumor characteristics, microsatellite instability (MSI), lymph node assessment, mortality rates, and 3-year survival. Differences were summarized using proportions, rate ratios, and percentage point changes. Results: Of 55,658 CRC cases, 4,398 (7.9%) were from East Texas. Compared to the rest of Texas, East Texas patients were more likely to be ≥65 years (58.5% vs 51.1%, *P* < 0.001) and Black (15.5% vs 12.9%, *P* < 0.001). They had higher frequencies of cecal tumors, localized disease, and lower rates of MSI-high tumors. CRC-specific mortality was higher in East Texas (16.9 vs 14.7 per 100,000; RR 1.15), especially among patients aged 40–64 (RR 1.40) and Black individuals (RR 1.21). Three-year survival was consistently lower in East Texas for key groups: 40–64-year-olds (66.2% vs 73.5%, −7.3 percentage points), Black patients (61.5% vs 65.8%, −4.3), localized stage (86.9% vs 92.3%, −5.4), and poorly differentiated tumors (39.8% vs 50.2%, −10.4). Notably, survival was equivalent in those ≥65 and similar in MSI-high tumors. Conclusion: East Texas CRC patients experience higher mortality and worse 3-year survival across multiple subgroups, including those aged 40–64, Black patients, and individuals with localized or high-grade tumors. These differences persist despite a similar stage distribution and lymph node assessment, suggesting non-biological contributors to outcome disparities. Our findings underscore the need for targeted, region-specific interventions to improve access to timely diagnosis, treatment, and longitudinal cancer care in East Texas.