Department of Population Health Science and Policy, Institute for Translational Epidemiology.
Department of Epidemiology and Population Health, NYU School of Medicine, New York, NY.
Am J Clin Oncol. 2020 Oct;43(10):741-747. doi: 10.1097/COC.0000000000000740.
Sociodemographic disparities in lung cancer prevalence, treatment options offered, and outcomes have been well documented. In stage I non-small cell lung cancer (NSCLC), the standard of care is surgical resection. This study explores disparities in surgical recommendations in stage I NSCLC, when surgery is considered curative.
Patients diagnosed with primary stage I NSCLC from 2007 to 2016 were identified from the Surveillance, Epidemiology, and End Results database (N=56,534). Associations between sociodemographic variables and surgical recommendation were assessed using multivariable logistic regression models. Survival impact was investigated using Cox-proportional hazards regression and propensity matching techniques.
Of the 76.9% patients recommended surgery, 95% underwent surgery. Recommended surgery was inversely associated with increasing age (P<0.01), non-Hispanic Black race (adjusted odds ratio [ORadj] 0.64, 95% confidence interval [CI]: 0.59-0.70), Hispanic ethnicity (ORadj 0.75, 95% CI: 0.67-0.84), nonprivate/Medicare insurance (Medicaid: ORadj 0.55, 95% CI: 0.51-0.60; insured with unknown plan: ORadj 0.74, 95% CI: 0.69-0.79; uninsured: ORadj 0.45, 95% CI: 0.36-0.55), and single status (ORadj 0.66, 95% CI: 0.63-0.70). Patients who were not recommended surgery were at increased risk of death compared with those who were recommended.
In a cohort of NSCLC patients, nonclinical factors identified a subgroup of patients who were less likely to be recommended surgery.
肺癌发病率、提供的治疗选择和结局的社会人口统计学差异已有充分记录。在 I 期非小细胞肺癌（NSCLC）中，标准治疗方法是手术切除。本研究探讨了在考虑手术为治愈方法的 I 期 NSCLC 中，手术建议存在差异的情况。
从监测、流行病学和最终结果数据库（N=56534）中确定了 2007 年至 2016 年期间被诊断为原发性 I 期 NSCLC 的患者。使用多变量逻辑回归模型评估社会人口统计学变量与手术建议之间的关联。使用 Cox 比例风险回归和倾向匹配技术研究了生存影响。
在建议手术的 76.9%患者中，95%接受了手术。推荐手术与年龄增加呈负相关（P<0.01），非西班牙裔黑人种族（调整后比值比 [ORadj] 0.64，95%置信区间 [CI]：0.59-0.70），西班牙裔（ORadj 0.75，95% CI：0.67-0.84），非私人/医疗保险（医疗补助：ORadj 0.55，95% CI：0.51-0.60；保险计划未知：ORadj 0.74，95% CI：0.69-0.79；未参保：ORadj 0.45，95% CI：0.36-0.55）和单身状态（ORadj 0.66，95% CI：0.63-0.70）。与被建议手术的患者相比，未被建议手术的患者死亡风险增加。
在 NSCLC 患者队列中，非临床因素确定了一组不太可能被建议手术的患者。
