American Cancer Society, Atlanta, Georgia.
Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
J Thorac Oncol. 2016 Jun;11(6):880-9. doi: 10.1016/j.jtho.2016.03.003. Epub 2016 Mar 12.
Previous studies reported racial and socioeconomic disparities in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) in the United States. We examined variation in receipt of surgery and whether the racial disparity varies by state.
Patients in whom stage I or II NSCLC was diagnosed from 2007 to 2011 were identified from 38 state and the District of Columbia population-based cancer registries compiled by the North American Association of Central Cancer Registries. Percentage of patients receiving curative-intent surgery was calculated for each registry. Adjusted risk ratios were generated by using modified Poisson regression to control for sociodemographic (e.g., age, sex, race, insurance) and clinical (e.g., grade, stage) factors. Non-Hispanic (NH) whites and Massachusetts were used as references for comparisons because they had the lowest uninsured rates.
In all registries combined, 66.4% of patients with early-stage NSCLC (73,475 of 110,711) received curative-intent surgery. Receipt of curative-intent surgery for early-stage NSCLC varied substantially by state, ranging from 52.2% to 56.1% in Wyoming, Louisiana, and New Mexico to 75.2% to 77.2% in Massachusetts, New Jersey, and Utah. In a multivariable analysis, the likelihood of receiving curative-intent surgery was significantly lower in all but nine states/registries compared with Massachusetts, ranging from 7% lower in California to 25% lower in Wyoming. Receipt of curative-intent surgery for early-stage NSCLC was lower for NH blacks than for NH whites in every state, although statistically significant in Florida and Texas.
Receipt of curative-intent surgery for early-stage NSCLC varies substantially across states in the United States, with northeastern states generally showing the highest rates. Further, receipt of treatment appeared to be lower in NH blacks than in NH whites in every state, although statistically significant in Florida and Texas.
既往研究显示，在美国，接受根治性手术治疗的早期非小细胞肺癌（NSCLC）患者存在种族和社会经济差异。本研究旨在评估手术接受情况的差异，并探讨这种种族差异是否因州而异。
从北美癌症登记协会的 38 个州和哥伦比亚特区的癌症登记处获取 2007 年至 2011 年间诊断为 I 期或 II 期 NSCLC 的患者信息。为每个登记处计算接受根治性手术治疗的患者比例。采用修正泊松回归模型来控制社会人口统计学（如年龄、性别、种族、保险状况）和临床因素（如分级、分期），计算调整后的风险比。非西班牙裔（NH）白人和马萨诸塞州被用作参考，因为这两个地区的未参保率最低。
在所有登记处中，66.4%的早期 NSCLC 患者（110711 例中的 73475 例）接受了根治性手术治疗。早期 NSCLC 患者接受根治性手术治疗的情况因州而异，从怀俄明州、路易斯安那州和新墨西哥州的 52.2%到马萨诸塞州、新泽西州和犹他州的 75.2%至 77.2%不等。多变量分析显示，除 9 个州/登记处外，其余州/登记处接受根治性手术治疗的可能性均显著低于马萨诸塞州，加利福尼亚州低 7%，怀俄明州低 25%。在所有州中，NH 黑种人接受早期 NSCLC 根治性手术治疗的可能性均低于 NH 白种人，在佛罗里达州和得克萨斯州差异具有统计学意义。
美国各州接受早期 NSCLC 根治性手术治疗的情况存在显著差异，东北部各州的总体手术率较高。此外，在所有州中，NH 黑种人接受治疗的可能性均低于 NH 白种人，尽管在佛罗里达州和得克萨斯州差异具有统计学意义。
