Impact of race on outcomes of patients with non-small cell lung cancer
Impact of race on outcomes of patients with non-small cell lung cancer
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DOI：
10.1097/jto.0b013e31817c60c7
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发表时间：
2008-07-01
影响因子：
20.4
通讯作者：
Cerfolio, Robert James
中科院分区：
文献类型：
--
作者：
Bryant, Ayesha S.;Cerfolio, Robert James
目的：异质性治疗和分期策略、有限的国家登记、社会经济和随访数据阻碍了对可能导致肺癌患者种族差异的因素的研究。本研究检查了几十年的数据价值，以更好地阐明这些因素在队列分期或使用同质算法处理。方法：对非小细胞肺癌（NSCLC）患者进行巢式病例对照研究。白人患者与非裔美国患者在年龄、性别、合并症、表现状态和分期上的比例为4:1。所有患者均由一名医生使用相似的分期治疗算法进行临床和病理分期。通过人均年收入、保险状况和教育水平评估社会经济地位。主要终点是生存率。结果：在本系列的930例患者中，非洲裔美国人吸烟的可能性更大（p < 0.001），人均年收入较低（p = 0.016），治疗延迟较大（p = 0.023），同意新辅助治疗的可能性更小（p < 0.001）。白人在I期（84%对78%，p = 0.037）、II期（52%对44%，p = 0.041）和III期（32%对20%，p = 0.008） NSCLC的5年总生存率优于非裔美国人。然而，在调整社会经济地位和吸烟状况后，这种生存优势在早期NSCLC （I期和11期）中消失。当调整为新辅助放化疗时，IIIa期的生存优势丧失。与社会经济地位无关的所有亚组中，非洲裔美国男性的存活率最差。结论：考虑到统一的分期、治疗和社会经济地位，非裔美国人和白人nsclc患者的总体生存率相似。
Objective: Examination of factors that may contribute to racial disparity among those with lung cancer has been thwarted by heterogeneous treatment and staging strategies, limited national registry and socioeconomic and follow-up data. This study examines a decades worth of data to better elucidate these factors in a cohort staged or treated using homogeneous algorithms.Methods: A nested case-control study of patients with non-small cell lung cancer (NSCLC). White patients were matched 4:1 to African American patients on age, gender, comorbidities, performance status, and stage. All patients underwent clinical and pathologic staging by one physician using similar staged-based treatment algorithms. Socioeconomic status was assessed by annual income per capita, insurance status, and education level. The primary outcome was survival rate.Results: Among the 930 patients in this series, African Americans were more likely to be smokers (p < 0.001), have a lower per-capita annual income (p = 0.016), greater delay to treatment (p = 0.023), and less likely to agree to neo-adjuvant therapy (p < 0.001). Whites had better 5-year overall survival than African Americans for stage I (84% versus 78%, p = 0.037), stage II (52% versus 44%, p = 0.041), and stage III (32% versus 20%, p = 0.008) NSCLC. However, this survival advantage disappeared for earlier stages of NSCLC (I and 11) when adjusted for socioeconomic status and smoking status. The survival advantage for stage IIIa was lost when adjusted for neo-adjuvant chemoradiotherapy. African American men had the worst survival of all subgroups independent of socioeconomic status.Conclusions: Given uniform staging, treatment, and socioeconomic status the overall survival rates for African American and White patients with NSLC are similar.