Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Administration Medical Center, Durham, North Carolina; Division of Medical Oncology, Duke University Medical Center, North Carolina.
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
J Thorac Oncol. 2016 Oct;11(10):1672-81. doi: 10.1016/j.jtho.2016.05.030. Epub 2016 Jun 11.
Numerous reports suggest lower rates of surgical procedures and poorer survival for black patients with early-stage (stage I or II) NSCLC than for white patients. This study examined treatment trends among blacks and whites with early-stage NSCLC and determined whether racial disparities exist in survival among patients receiving similar treatment.
A retrospective analysis of 18,466 patients in the Veteran Affairs Central Cancer Registry in whom stage I or II NSCLC was diagnosed in 2001-2010 was conducted. Patients were categorized as receiving an operation, radiation, or other/no treatment. Overall survival (OS) and lung cancer-specific survival (LCSS) were evaluated using Kaplan-Meier and multivariable Cox regression analyses.
There was a statistically significant disparity between black and white patients receiving an operation that decreased over time to similar rates (p = 0.01). No significant racial differences in receipt of radiation were noted. Race was not associated with OS among all patients (hazard ratio [HR] = 0.97, 95% confidence interval [CI]: 0.93-1.02). Among patients who received an operation, no racial difference in OS was observed (HR = 0.94, 95% CI: 0.87-1.01), but the HR for blacks versus whites was 0.90 (95% CI: 0.82-0.98) for radiation treatment and 0.89 (95% CI: 0.81-0.97) for other/no treatment. Race was not associated with LCSS among all patients combined or within each treatment category.
A racial disparity in the rate of operation was no longer apparent at the end of the study period. There was no racial difference in OS or LCSS among all patients in this equal access health care system. Long-documented racial differences in lung cancer treatment and mortality result from disparity of access to health care and delivery of recommended treatment.
许多报告表明，与白人患者相比，患有早期（I 期或 II 期）非小细胞肺癌的黑人患者接受手术的比例较低，生存率也较低。本研究检查了早期非小细胞肺癌的黑人和白人患者的治疗趋势，并确定在接受相似治疗的患者中是否存在生存方面的种族差异。
对 2001 年至 2010 年间在退伍军人事务中央癌症登记处诊断为 I 期或 II 期非小细胞肺癌的 18466 例患者进行了回顾性分析。患者分为接受手术、放疗或其他/无治疗。使用 Kaplan-Meier 和多变量 Cox 回归分析评估总生存率（OS）和肺癌特异性生存率（LCSS）。
接受手术的黑人和白人患者之间存在统计学上显著的差异，但随着时间的推移，这一差异逐渐缩小，最终达到相似的比例（p=0.01）。在接受放疗方面，没有发现明显的种族差异。在所有患者中，种族与 OS 无关（风险比[HR]为 0.97，95%置信区间[CI]为 0.93-1.02）。在接受手术的患者中，未观察到 OS 方面的种族差异（HR 为 0.94，95% CI 为 0.87-1.01），但黑人与白人相比，接受放疗的 HR 为 0.90（95% CI 为 0.82-0.98），接受其他/无治疗的 HR 为 0.89（95% CI 为 0.81-0.97）。在所有患者或每个治疗类别中，种族均与 LCSS 无关。
在研究期末，手术率的种族差异已不再明显。在这个获得平等医疗保健的系统中，所有患者的 OS 或 LCSS 均无种族差异。在肺癌治疗和死亡率方面长期存在的种族差异源于获得医疗保健和提供推荐治疗方面的差异。
