Zeng Hui, Yuan Zhenlong, Zhang Guochao, Li Wenbin, Guo Lei, Li Ni, Xue Qi, Tan Fengwei
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Transl Lung Cancer Res. 2022 Jul;11(7):1348-1358. doi: 10.21037/tlcr-21-794.
Racial differences in lung cancer survival are well documented in the United States, but the fundamental causes are less clear. In this study we aimed to examine racial differences in lung cancer-specific survival (LCSS) and explore mediating factors.
We used the Surveillance, Epidemiology and End Results database to obtain data pertaining to lung cancer patients from 2004 to 2017. Outcome was LCSS and covariates included nonclinical (age at diagnosis, gender, marital status, race) and clinical factors (tumor site, year of diagnosis, tumor grading, histological subtype, tumor-node-metastasis (TNM) stage, surgery status, chemotherapy status and radiation status). Kaplan-Meier methods served for comparative LCSS disparities among patients of different racial origins. Meanwhile, univariate and multivariate survival analyses were performed to determine racial disparities in LCSS.
Among 61,961 lung cancer patients, 75.70% were White, 12.80% were Black, 11.30% were Asian or Pacific Islander (API), and 0.20% were American Indian/Alaska Native (AIAN). In API patients, adenocarcinoma patients (54.5%) were more frequent than in White patients (43.2%), Black patients (44.1%) and American Indian/Alaska Native patients (41.2%). Black and API patients exhibited higher stage than White patients (P<0.01). However, our multivariate analysis identified API patients exhibited better LCSS than White patients (HR: 0.90, 95% CI: 0.88-0.93). Kaplan-Meier survival analysis confirmed that API patients exhibited best LCSS, especially in stage IV adenocarcinoma.
The novel evidence obtained from this study enrich our knowledge of racial differences among lung cancer patients and suggest that race may be associated with LCSS.
美国肺癌生存率的种族差异已有充分记录，但根本原因尚不清楚。在本研究中，我们旨在研究肺癌特异性生存率（LCSS）的种族差异，并探索中介因素。
我们使用监测、流行病学和最终结果数据库获取2004年至2017年肺癌患者的数据。结局指标为LCSS，协变量包括非临床因素（诊断时年龄、性别、婚姻状况、种族）和临床因素（肿瘤部位、诊断年份、肿瘤分级、组织学亚型、肿瘤-淋巴结-转移（TNM）分期、手术状态、化疗状态和放疗状态）。采用Kaplan-Meier方法比较不同种族来源患者的LCSS差异。同时，进行单因素和多因素生存分析以确定LCSS的种族差异。
在61961例肺癌患者中，75.70%为白人，12.80%为黑人，11.30%为亚洲或太平洋岛民（API），0.20%为美国印第安人/阿拉斯加原住民（AIAN）。在API患者中，腺癌患者（54.5%）比白人患者（43.2%）、黑人患者（44.1%）和美国印第安人/阿拉斯加原住民患者（41.2%）更常见。黑人和API患者的分期高于白人患者（P<0.01）。然而，我们的多因素分析发现API患者的LCSS优于白人患者（HR：0.90，95%CI：0.88-0.93）。Kaplan-Meier生存分析证实，API患者的LCSS最佳，尤其是在IV期腺癌患者中。
本研究获得的新证据丰富了我们对肺癌患者种族差异的认识，并表明种族可能与LCSS相关。
