Race/ethnicity and lung cancer survival in the United States: a meta-analysis
Race/ethnicity and lung cancer survival in the United States: a meta-analysis
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DOI：
10.1007/s10552-019-01229-4
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发表时间：
2019-11-01
影响因子：
2.3
通讯作者：
Hosgood, H. Dean, III
中科院分区：
文献类型：
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作者：
Klugman, Madelyn;Xue, Xiaonan;Hosgood, H. Dean, III
目的肺癌死亡率在癌症登记中被证明因种族和民族而不同；然而，研究通常不考虑吸烟状况。我们试图总结种族和民族对美国肺癌患者生存的独立贡献，考虑到包括吸烟状况在内的重要变量。方法使用PubMed软件确定1877项潜在合格研究，其中纳入27项。如果研究没有考虑年龄、种族和/或民族以及吸烟状况，则被排除在外。固定和随机效应荟萃分析使用报告的调整风险比(HR)的西班牙裔、亚裔和非裔美国人与非西班牙裔白人(NHW)比较。结果拉美裔和亚裔与降低的调整死亡风险相关(西班牙裔：N研究=5，N研究=108,810，HR=0.95，95%CI 0.90~1.00；亚洲：N研究=6，N研究=128,950，HR=0.86，95%CI 0.81~0.90)。排除完全不吸烟者的研究时，结果是相似的。调整后非裔美国人和白人的存活率差异无统计学意义(N研究=10，N受试者=131,378，HR=0.98，95%CI 0.96~1.01)。女性(HR=0.88，95%CI为0.87~0.89)、未婚(HR=1.08，95%CI为1.04~1.11)、是否吸烟(HR=1.11，95%CI为1.08~1.15)、合并症(HR=1.39，95%CI为1.24~1.56)、接受治疗(HR=0.33，95%CI为0.32~0.34)、放射治疗：HR=0.87，95%CI为0.85~0.88；化疗：HR=0.64，95%可信区间0.63~0.65)。结论即使在调整了临床因素和吸烟状况后，拉美裔和亚洲人的存活率仍高于卫生工作者。需要进一步的研究来阐明这些生存差距的驱动因素。
Purpose Lung cancer mortality has been shown to vary by race and ethnicity in cancer registries; however, studies often do not account for smoking status. We sought to summarize the independent contribution of race and ethnicity to survival in US lung cancer patients, accounting for important variables including smoking status.Methods PubMed was used to identify 1,877 potentially eligible studies of which 27 were included. Studies were excluded if they did not account for age, race and/or ethnicity, and smoking status. Fixed- and random-effects meta-analyses were conducted using the reported adjusted hazard ratios (HR) of Hispanic ethnicity and Asian and African-American race compared to Non-Hispanic whites (NHWs) on overall survival in lung cancer.Results Hispanic ethnicity and Asian race were associated with decreased adjusted risk of death (Hispanic: N-studies = 5, N-subjects = 108,810, HR = 0.95, 95% CI 0.90-1.00; Asian: N-studies = 6, N-subjects = 128,950, HR = 0.86, 95% CI 0.81-0.90). The results were similar when excluding studies of solely never-smokers. There was no significant difference in survival between African-American and white race after adjustment (N-studies = 10, N-subjects = 131,378, HR = 0.98, 95% CI 0.96-1.01). Other prognostic factors were female gender (HR = 0.88, 95% CI 0.87-0.89), unmarried status (HR = 1.08, 95% CI 1.04-1.11), ever-smoking status (HR = 1.11, 95% CI 1.08-1.15), having comorbidities (HR = 1.39, 95% CI 1.24-1.56), and treatment receipt (surgery: HR = 0.33, 95% CI 0.32-0.34; radiation: HR = 0.87, 95% CI 0.85-0.88; chemotherapy: HR = 0.64, 95% CI 0.63-0.65).Conclusions Even after adjustment for clinical factors and smoking status, Hispanics and Asians experienced improved survival compared to NHWs. Future studies are needed to elucidate the drivers of these survival disparities.