Racial Differences in Survival Among Advanced-stage Non-small-Cell Lung Cancer Patients Who Received Immunotherapy: An Analysis of the US National Cancer Database (NCDB)
Racial Differences in Survival Among Advanced-stage Non-small-Cell Lung Cancer Patients Who Received Immunotherapy: An Analysis of the US National Cancer Database (NCDB)
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DOI：
10.1097/cji.0000000000000400
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发表时间：
2022-02-01
影响因子：
3.9
通讯作者：
Akinyemiju, Tomi
中科院分区：
文献类型：
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作者：
Gupta, Anjali;Zhang, Dongyu;Akinyemiju, Tomi
肺癌是美国男性和女性癌症死亡的最常见原因，在生存方面存在显著的种族差异。目前尚不清楚这些差异是否在平等利用免疫疗法后持续存在。本研究的目的是评估种族与接受免疫治疗的非小细胞肺癌（NSCLC）患者全因死亡率之间的关系。我们从2016年国家癌症数据库中获得了2015年至2016年诊断为晚期（III-IV）NSCLC患者的数据。使用多变量考克斯比例风险模型计算不同人种/种族的风险比（HR）和95%置信区间（95% CI）。共纳入2940例患者。在调整社会人口统计学、临床和治疗因素后，非西班牙裔（NH）黑人患者的死亡风险低于NH白人患者（HR：0.85; 95% CI：0.73，0.98）。正式测试的相互作用评估种族与Charlson-Deyo comorbidity评分和种族与地区水平的中位数收入是不显着的。然而，在分层分析中，在调整了社会人口学因素的模型中，在至少有1种合并症的患者（HR：0.75; 95% CI：0.57，0.97）和生活在中位收入最低的2个四分位数内的患者（HR：0.82; 95% CI：0.68，0.99）中，NH黑人患者的死亡风险低于NH白人患者。在接受免疫治疗的晚期NSCLC患者中，NH-黑人患者的生存率高于NH-白人患者。我们敦促实施政策和干预措施，寻求平等获得护理，作为解决种族间NSCLC总体生存差异的一种手段。
Lung cancer is the most common cause of cancer death among men and women in the United States, with significant racial disparities in survival. It is unclear whether these disparities persist upon equal utilization of immunotherapy. The purpose of this study was to evaluate the association between race and all-cause mortality among non-small-cell lung cancer (NSCLC) patients who received immunotherapy. We obtained data from the 2016 National Cancer Database on patients diagnosed with advanced-stage (III-IV) NSCLC from 2015 to 2016. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) by race/ethnicity. A total of 2940 patients were included. Non-Hispanic (NH)-Black patients had a lower risk of death relative to NH-White patients (HR: 0.85; 95% CI: 0.73, 0.98) after adjusting for sociodemographic, clinical, and treatment factors. Formal tests of interaction evaluating race with Charlson-Deyo comorbidity score and race with area-level median income were nonsignificant. However, in stratified analyses, NH-Black versus NH-White patients had a lower risk of death in models adjusted for sociodemographic factors among those with at least 1 comorbidity (HR: 0.75; 95% CI: 0.57, 0.97), and those living in regions within the 2 lowest quartiles of median income (HR: 0.82; 95% CI: 0.68, 0.99). Among advanced-stage NSCLC patients who received immunotherapy, NH-Black patients experienced higher survival compared with NH-White patients. We urge the implementation of policies and interventions that seek to equalize access to care as a means of addressing differences in overall NSCLC survival by race.