Keck School of Medicine, University of Southern California, Los Angeles, California.
Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
Ann Thorac Surg. 2020 Jan;109(1):225-232. doi: 10.1016/j.athoracsur.2019.07.017. Epub 2019 Aug 28.
Treatment decisions for patients with non-small cell lung cancer (NSCLC) are based on patient and tumor characteristics, including socioeconomic status (SES) factors. The objective was to assess the contribution of SES factors to treatment and outcomes among patients with stage I NSCLC.
The National Cancer Database was queried for operable patients with stage I NSCLC. Patients were divided into three treatment groups: primary resection (ie, surgery only); nonstandard treatments consisting of chemotherapy with or without radiation; and no therapy. The SES of patients who made up the treatment groups was assessed, and the 5-year survival of all groups was analyzed.
The cohort included 69,168 patients with stage I NSCLC. Each of these patients had between zero and five SES risk factors. The factors associated with no surgery were low income, nonwhite race, low high school graduation rate, Medicaid or no insurance, rural residence, and distance less than 12.5 miles from treatment facility. Patients with several SES risk factors have linearly increasing odds of undergoing nonstandard treatments and quadratically increasing odds of having no therapy (for patients with five factors, to odds ratio 4.7; 95% confidence interval, 3.44 to 6.30). Surgery alone was associated with significantly longer 5-year survival (71.8%) compared with nonstandard treatments (22.7%) and no therapy (21.8%; P < .001).
Socioeconomic status factors increase the risk of undergoing guideline discordant therapy for stage I NSCLC. As the number of SES factors increases, the odds of no therapy rises quadratically whereas the odds of nonstandard treatments rises constantly. The surgery only group had significantly longer survival than the nonstandard treatment and no therapy groups.
非小细胞肺癌（NSCLC）患者的治疗决策基于患者和肿瘤特征，包括社会经济地位（SES）因素。目的是评估 SES 因素对 I 期 NSCLC 患者治疗和结局的贡献。
国家癌症数据库对可手术的 I 期 NSCLC 患者进行了查询。患者分为三组治疗：原发切除术（即仅手术）；非标准治疗包括化疗加或不加放疗；以及无治疗。评估构成治疗组的患者的 SES，并分析所有组的 5 年生存率。
该队列包括 69168 名 I 期 NSCLC 患者。这些患者每人的 SES 危险因素为 0 至 5 个。与未行手术相关的因素是低收入、非白种人、高中毕业率低、医疗补助或无保险、农村居住和距治疗机构的距离小于 12.5 英里。SES 危险因素较多的患者接受非标准治疗的可能性呈线性增加，且无治疗的可能性呈二次增加（对于有五个危险因素的患者，比值比为 4.7；95%置信区间，3.44 至 6.30）。单独手术与非标准治疗（22.7%）和无治疗（21.8%；P<0.001）相比，5 年生存率显著延长（71.8%）。
SES 因素增加了 I 期 NSCLC 患者接受指南不一致治疗的风险。随着 SES 因素数量的增加，无治疗的可能性呈二次增加，而非标准治疗的可能性呈线性增加。仅手术组的生存时间明显长于非标准治疗组和无治疗组。
