Vyfhuis Melissa A L, Bhooshan Neha, Molitoris Jason, Bentzen Søren M, Feliciano Josephine, Edelman Martin, Burrows Whitney M, Nichols Elizabeth M, Suntharalingam Mohan, Donahue James, Nagib Marc, Carr Shamus R, Friedberg Joseph, Badiyan Shahed, Simone Charles B, Feigenberg Steven J, Mohindra Pranshu
Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, United States.
Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, United States.
Lung Cancer. 2017 Dec;114:44-49. doi: 10.1016/j.lungcan.2017.10.016. Epub 2017 Nov 2.
OBJECTIVES: The black population remains underrepresented in clinical trials despite reports suggesting greater incidence and deaths from locally advanced non-small cell lung cancer (NSCLC). We determined outcomes for black and non-black patients in a well-annotated cohort treated with either definitive chemoradiation (CRT; bimodality) or CRT followed by surgery (trimodality therapy). MATERIALS AND METHODS: A retrospective analysis of 355 stage III NSCLC patients treated with curative intent at the University of Maryland, Medical Center, between January 2000-December 2013 was performed. The Kaplan-Meier approach and the Cox proportional hazards models were used to analyze overall survival (OS) and freedom-from-recurrence (FFR) in black and non-black patients. The chi-square test was used to compare categorical variables. RESULTS: Black patients comprised 42% of the cohort and were more likely to be younger (p<0.0001), male (p=0.030), single (p<0.0001), reside in lower household income zipcodes (p<0.0001), have an Eastern Cooperative Oncology Group (ECOG) performance status >0 (p<0.001), and less likely to undergo surgery (p<0.0001). With a median follow-up of 15 months for all patients and 89 months for surviving patients (range:1-186 months), median OS times for black and non-black patients were 22 and 24 months, respectively (p=0.698). FFR rates were also comparable between the two groups (p=0.468). Surgery improved OS in both cohorts. Race was not a significant predictor for OS or FFR even when adjusted for other factors. CONCLUSIONS: We found similar oncologic outcomes in black and non-black NSCLC patients when treated with curative intent in a comprehensive cancer center setting, despite epidemiologic differences in presentation and receipt of care. Future efforts to improve outcomes in black patients could focus on addressing modifiable social disparities.
目的:尽管有报告显示局部晚期非小细胞肺癌(NSCLC)的发病率和死亡率在黑人中更高,但黑人在临床试验中的代表性仍然不足。我们确定了在接受根治性放化疗(CRT;双峰治疗)或CRT后手术(三联治疗)的一个注释完善的队列中,黑人和非黑人患者的治疗结果。 材料与方法:对2000年1月至2013年12月在马里兰大学医学中心接受根治性治疗的355例III期NSCLC患者进行回顾性分析。采用Kaplan-Meier法和Cox比例风险模型分析黑人和非黑人患者的总生存期(OS)和无复发生存期(FFR)。采用卡方检验比较分类变量。 结果:黑人患者占队列的42%,更可能年龄较小(p<0.0001)、为男性(p=0.030)、单身(p<0.0001)、居住在家庭收入较低的邮政编码区域(p<0.0001)、东部肿瘤协作组(ECOG)体能状态>0(p<0.001),且接受手术的可能性较小(p<0.0001)。所有患者的中位随访时间为15个月,存活患者为89个月(范围:1 - 186个月),黑人和非黑人患者的中位OS时间分别为22个月和24个月(p=0.698)。两组的FFR率也相当(p=0.468)。手术改善了两个队列的OS。即使在调整其他因素后,种族也不是OS或FFR的显著预测因素。 结论:我们发现在综合癌症中心环境中,以根治性意图治疗时,黑人和非黑人NSCLC患者的肿瘤学结果相似,尽管在疾病表现和接受治疗方面存在流行病学差异。未来改善黑人患者治疗结果的努力可侧重于解决可改变的社会差异。
J Immigr Minor Health. 2020-12