The association of race and curative-intent treatment with mortality outcomes among early-stage NSCLC.

Authors

null

Qinran Liu

Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL

Qinran Liu , Tulay Koru-Sengul , Gilberto Lopes , Paulo S. Pinheiro

Organizations

Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, Sylvester Comprehensive Cancer Center, Department of Medicine, University of Miami School of Medicine, Miami, FL

Research Funding

Other Government Agency
Bankhead Coley Grant #20B16 from the Biomedical Research Program of the Department of Health State of Florida

Background: Racial disparities in early-stage non-small cell lung cancer (NSCLC) survival have persisted between blacks and whites in the past few decades. The role of receipt of curative-intent surgery and/or stereotactic body radiation therapy (SBRT) in this disparity is unclear. We examined the associations of race/ethnicity and curative-intent treatment (surgery and/or SRBT) with mortality outcomes among early-stage NSCLC patients, using population-based data from Florida, the third largest state in the US and the second state in the number of cancer cases diagnosed annually. Methods: Florida Cancer Data System (FCDS) data were used to estimate cancer-specific mortality for all patients diagnosed in the state between 2007 to 2018 for each racial/ethnic group: non-Hispanic black (NHB), Hispanic, and Asian/Pacific Islander (API)) and non-Hispanic whites (NHW). FCDS were further individually linked to population-based discharge data (94% match rate) containing patient-level comorbidities and treatment-specific information. Multivariable Cox proportional hazards regression models were applied to study the association of race/ethnicity and curative-intent treatment with lung cancer-specific mortality (LCSM). Competing risk analysis (deaths by other causes) for LCSM was performed. Results: We identified 63,872 early-stage NSCLC patients; 83.2% NHW, 6.6% NHB, 8.7% Hispanic, 0.77% API, and 0.79% other races; 72.2% of patients received curative-intent treatment (surgery and/or SRBT). The median lung cancer-specific survival time for all patients was 5.43 years (95% CI, 5.30-5.56). After inclusion of all clinical and sociodemographic factors including stage at diagnosis and comorbidities, race/ethnicity (NHB vs NHW: hazard ratio [HR], 1.06; 95% CI, 1.00-1.11) and curative-intent treatment (SBRT vs curative-intent surgery: HR, 1.87; 95% CI, 1.78-1.97;) were both independently associated with LCSM. Nevertheless, after combining the effect of race/ethnicity and curative-intent treatment in the same fully adjusted model, NHB patients who received curative-intent treatment experienced nearly identical survival as their NHW counterparts (HR, 0.95; 95% CI, 0.87-1.03). Similar findings were observed in competing risk analysis (subdistribution hazard ratio [sHR], 0.97; 95% CI: 0.89-1.02). Conclusions: In this racially diverse population, receipt of curative-intent treatment revealed comparable survival between NHB and NHW patients. The results underscore the importance of considering receipt of (specifically) curative-intent treatment rather than receipt of any form of surgery or radiotherapy in racial/ethnic survival disparities. The uptake of curative-intent surgery and SBRT, which currently stands at 56.5% and 9.4% respectively, should be increased to improve survival outcomes for early-stage NSCLC for all.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Lung Cancer—Non-Small Cell Local-Regional/Small Cell/Other Thoracic Cancers

Track

Lung Cancer

Sub Track

Local-Regional Non–Small Cell Lung Cancer

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e20563)

DOI

10.1200/JCO.2023.41.16_suppl.e20563

Abstract #

e20563

Abstract Disclosures

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