Racial differences in clinical, genomic, and survival outcomes in colorectal cancer.

10593 Background: Racial differences influence colorectal cancer incidence, biology, and survival, but the clinical and genomic drivers remain unclear. This study evaluates race-based variation in clinical features, metastatic patterns, and key mutations in a large real-world cohort to improve risk stratification and promote equitable treatment. Methods: Clinical and genomic data were obtained from MSK-CHORD via cBioPortal, including patients identified as Asian, White, or Black. Variables were analysed in RStudio. Group differences were assessed using chi-square, Fisher’s exact tests, or Kruskal–Wallis. Survival was analysed with Kaplan–Meier and Cox models. Significance was set at p 0.05). Overall survival varied significantly (p < 0.001), highest in Asians (71.6 months) and Whites (54.3 months) and lowest in Blacks (32.3 months); Asians had similar mortality risk to Whites (HR 0.94), whereas Blacks had higher risk (HR 1.44). Genomic variation was notable: KRAS (p = 1.6×10⁻⁷) was highest in Blacks (56.8%), TP53 (p < 0.001) was highest in Asians (81.5%), and BRAF (p = 0.0046) was lowest in Blacks (7.1%), with no other genes differing. Conclusions: Racial differences were evident across outcomes. Black patients had the highest KRAS mutations and worst survival; Asians had the highest TP53 rates and best survival; Whites had the most MSI-H tumours. Other clinical features were similar. These patterns suggest biologic differences relevant to risk and treatment.