Manali I. Patel, Scarlett L. Gomez, Ellen T. Chang, and Heather A. Wakelee, Stanford University; Scarlett L. Gomez and Heather A. Wakelee, Stanford Cancer Institute, Stanford; Clayton W. Schupp and Scarlett L. Gomez, Cancer Prevention Institute of California, Fremont; and Ellen T. Chang, Exponent Health Sciences Practices, Menlo Park, CA.
J Clin Oncol. 2013 Oct 1;31(28):3572-8. doi: 10.1200/JCO.2012.48.6217. Epub 2013 Aug 19.
Hispanics in the United States have lower age-adjusted mortality resulting from non-small-cell lung cancer (NSCLC) compared with non-Hispanic whites (NHWs). The purpose of this study was to evaluate individual, clinical, and neighborhood factors in survival among Hispanics with NSCLC.
We performed a retrospective analysis of NHWs and Hispanics with NSCLC between 1998 and 2007 in the California Cancer Registry (follow-up to December 2009). Kaplan-Meier curves depict survival by nativity for Hispanics with NSCLC. Cox proportional hazards models estimated hazard of mortality by race with adjustment for individual (age, sex, marital status), clinical (histologic grade, surgery, irradiation, chemotherapy), and neighborhood factors (neighborhood socioeconomic status, ethnic enclave).
We included 14,280 Hispanic patients with NSCLC. Foreign-born Hispanics had 15% decreased risk of disease-specific mortality resulting from NSCLC compared with NHWs (hazard ratio [HR], 0.85; 95% CI, 0.83 to 0.88) after adjustment for individual, clinical, and neighborhood factors. After adjustment for individual factors, compared with US-born Hispanics, foreign-born Hispanics had 10% decreased risk of disease-specific mortality (HR, 0.90; 95% CI, 0.87 to 0.96). Clinical and neighborhood factors slightly moderated the survival benefit for foreign-born patients. A modestly more pronounced survival advantage was seen for foreign-born Hispanics living in low socioeconomic and high Hispanic enclave neighborhoods as compared with US-born Hispanics (HR, 0.86; 95% CI, 0.81 to 0.90).
Foreign-born Hispanics with NSCLC have a decreased risk of disease-specific mortality compared with NHWs and US-born Hispanics with NSCLC. Neighborhood factors slightly moderate this survival advantage. This survival advantage is slightly more pronounced in lower socioeconomic and higher Hispanic enclave neighborhoods.
与非西班牙裔白人（NHW）相比，美国的西班牙裔人群死于非小细胞肺癌（NSCLC）的年龄调整死亡率较低。本研究旨在评估西班牙裔 NSCLC 患者的个体、临床和社区因素对生存的影响。
我们对 1998 年至 2007 年间加利福尼亚癌症登记处的 NHW 和西班牙裔 NSCLC 患者进行了回顾性分析（随访至 2009 年 12 月）。Kaplan-Meier 曲线描绘了西班牙裔 NSCLC 患者的生存情况。Cox 比例风险模型估计了种族与个体（年龄、性别、婚姻状况）、临床（组织学分级、手术、放疗、化疗）和社区因素（社区社会经济地位、族裔飞地）之间的死亡率风险比。
我们纳入了 14280 名西班牙裔 NSCLC 患者。在调整了个体、临床和社区因素后，与 NHW 相比，出生在国外的西班牙裔患者死于 NSCLC 的疾病特异性死亡率降低了 15%（风险比[HR]，0.85；95%置信区间[CI]，0.83 至 0.88）。与美国出生的西班牙裔患者相比，在调整了个体因素后，出生在国外的西班牙裔患者死于疾病特异性死亡率的风险降低了 10%（HR，0.90；95%CI，0.87 至 0.96）。临床和社区因素略微缓和了对外国出生患者的生存获益。与美国出生的西班牙裔患者相比，出生在国外、居住在社会经济水平较低和西班牙裔飞地较多的社区的西班牙裔患者的生存优势略为明显（HR，0.86；95%CI，0.81 至 0.90）。
与 NHW 和美国出生的西班牙裔 NSCLC 患者相比，出生在国外的西班牙裔 NSCLC 患者的疾病特异性死亡率降低。社区因素略微缓和了这种生存优势。在社会经济水平较低和西班牙裔飞地较多的社区，这种生存优势更为明显。
