The Effect of Socioeconomic Status on Treatment and Mortality in Non-Small Cell Lung Cancer Patients
The Effect of Socioeconomic Status on Treatment and Mortality in Non-Small Cell Lung Cancer Patients
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DOI：
10.1016/j.athoracsur.2019.07.017
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发表时间：
2020-01-01
影响因子：
4.6
通讯作者：
David, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Ebner, Peggy J.;Ding, Li;David, Elizabeth A.
背景。非小细胞肺癌（NSCLC）患者的治疗决策基于患者和肿瘤特征，包括社会经济地位（SES）因素。目的是评估SES因素对I期非小细胞肺癌患者治疗和预后的影响。国家癌症数据库查询可手术的I期非小细胞肺癌患者。患者分为三个治疗组：一期切除（即仅手术）；非标准治疗，包括有或没有放射的化疗；也没有治疗。评估各治疗组患者的SES，并分析各治疗组患者的5年生存率。该队列包括69,168例I期NSCLC患者。这些患者中的每一个都有0到5个SES风险因素。与不接受手术相关的因素包括低收入、非白人种族、低高中毕业率、医疗补助或无保险、农村居住以及距离治疗机构小于12.5英里。具有多个SES危险因素的患者接受非标准治疗的几率呈线性增加，未接受治疗的几率呈二次增加（对于具有5个因素的患者，优势比为4.7；95%可信区间为3.44 ~ 6.30）。单独手术与非标准治疗（22.7%）和不治疗（21.8%）相比，5年生存率（71.8%）明显延长。社会经济地位因素增加了I期NSCLC接受指南不一致治疗的风险。随着社会经济地位因素的增加，不接受治疗的几率呈二次增长，而接受非标准治疗的几率则不断上升。单纯手术组的生存期明显长于非标准治疗组和无治疗组。
Background. Treatment decisions for patients with non-small cell lung cancer (NSCLC) are based on patient and tumor characteristics, including socioeconomic status (SES) factors. The objective was to assess the contribution of SES factors to treatment and outcomes among patients with stage I NSCLC.Methods. The National Cancer Database was queried for operable patients with stage I NSCLC. Patients were divided into three treatment groups: primary resection (ie, surgery only); nonstandard treatments consisting of chemotherapy with or without radiation; and no therapy. The SES of patients who made up the treatment groups was assessed, and the 5-year survival of all groups was analyzed.Results. The cohort included 69,168 patients with stage I NSCLC. Each of these patients had between zero and five SES risk factors. The factors associated with no surgery were low income, nonwhite race, low high school graduation rate, Medicaid or no insurance, rural residence, and distance less than 12.5 miles from treatment facility. Patients with several SES risk factors have linearly increasing odds of undergoing nonstandard treatments and quadratically increasing odds of having no therapy (for patients with five factors, to odds ratio 4.7; 95% confidence interval, 3.44 to 6.30). Surgery alone was associated with significantly longer 5-year survival (71.8%) compared with nonstandard treatments (22.7%) and no therapy (21.8%; P < .001).Conclusions. Socioeconomic status factors increase the risk of undergoing guideline discordant therapy for stage I NSCLC. As the number of SES factors increases, the odds of no therapy rises quadratically whereas the odds of nonstandard treatments rises constantly. The surgery only group had significantly longer survival than the nonstandard treatment and no therapy groups.