Division of Thoracic Surgery, Department of Surgery.
Division of Biostatistics, Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, California.
Ann Thorac Surg. 2020 May;109(5):1512-1520. doi: 10.1016/j.athoracsur.2019.11.059. Epub 2020 Jan 24.
Socioeconomic status (SES) disparities in the surgical management of patients with non-small cell lung cancer (NSCLC) are well described. Disparities in the receipt of adjuvant chemotherapy are poorly understood. We assessed the influence of SES on adjuvant chemotherapy after resection in patients with pN1 NSCLC.
The National Cancer Database was queried for cN0/N1 NSCLC patients who underwent surgical resection and had demonstrated pN1 disease. This cohort was further divided into those who received multiagent adjuvant chemotherapy (MAAC) vs surgery-only treatment. Factors associated with treatment assignment were examined, and long-term survival was compared.
Of the 14,892 patients who underwent resection for pN1 disease, 8061 (54.1%) received MAAC. Patients were less likely to receive MAAC if they resided in rural areas (odds ratio, 1.23; 95% confidence interval [CI], 1.11-1.37; P < .001), or were uninsured or on Medicaid (odds ratio, 1.23; 95% CI, 1.07-1.41; P = .004). The propensity score-weighted 5-year survival was significantly higher for those receiving MAAC compared with surgery only (53.6% vs 39.5%, log-rank P < .001). Lower income (hazard ratio, 1.06; 95% CI, 1.00-1.12; P = .044) and uninsured or Medicaid insurance status (hazard ratio, 1.22; 95% CI, 1.13-1.31; P < .001) were independently associated with increased mortality by Cox regression in the propensity score-weighted cohort.
pN1 NSCLC patients living in rural areas or who are uninsured or on Medicaid insurance are at increased risk of not receiving MAAC. Treatment with MAAC significantly improves long-term survival of pN1 patients. Efforts should be made to ensure these at-risk groups receive guideline-concordant care.
社会经济地位（SES）在非小细胞肺癌（NSCLC）患者的手术治疗方面存在明显差异。但对于接受辅助化疗的差异却知之甚少。我们评估了 SES 对接受 pN1 NSCLC 切除术患者辅助化疗的影响。
国家癌症数据库查询了接受手术切除且 pN1 疾病的 cN0/N1 NSCLC 患者。该队列进一步分为接受多药辅助化疗（MAAC）与单纯手术治疗的患者。检查了与治疗分配相关的因素，并比较了长期生存情况。
在 14892 例接受 pN1 疾病切除术的患者中，8061 例（54.1%）接受了 MAAC。如果患者居住在农村地区（优势比，1.23；95%置信区间[CI]，1.11-1.37；P<.001）或没有保险或享受医疗补助（优势比，1.23；95%CI，1.07-1.41；P=.004），则不太可能接受 MAAC。与单纯手术相比，接受 MAAC 的患者 5 年生存率显著提高（53.6%比 39.5%，对数秩 P<.001）。在倾向评分加权队列中，Cox 回归分析显示，较低的收入（风险比，1.06；95%CI，1.00-1.12；P=.044）和没有保险或医疗补助保险状态（风险比，1.22；95%CI，1.13-1.31；P<.001）与死亡风险增加独立相关。
居住在农村地区、没有保险或享受医疗补助的 pN1 NSCLC 患者接受 MAAC 的风险增加。接受 MAAC 治疗显著改善了 pN1 患者的长期生存。应努力确保这些高危人群接受符合指南的治疗。
