Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Division of Pulmonary Medicine and Critical Care, Thomas Jefferson University Hospital, Philadelphia, PA.
Clin Lung Cancer. 2022 Nov;23(7):e460-e472. doi: 10.1016/j.cllc.2022.07.006. Epub 2022 Jul 29.
There remain profound race-related disparities in the treatment of non-small cell lung cancer (NSCLC). Deferral of operative management for early-stage disease is recognized as driver of this disparity. Black race has been associated with higher rates of surgical deferral. It remains unclear how race impacts likelihood of receiving radiation therapy after declining surgical management of NSCLC.
A retrospective cohort analysis was completed using data from the National Cancer Database (NCBD) for patients 18 and over with stage I NSCLC offered surgical resection from 2004 to 2015 (N = 89,462). Multivariable logistic regression identified predictors of surgical deferral and predictors for deferral of radiation after deferral of surgery. Kaplan-Meier survival analysis with log-rank tests and multivariable Cox proportional hazards regressions were performed.
87,293 (97.6%) patients underwent surgery, 2169 (2.4%) deferred. Patients who deferred had 2.1 times higher hazard ratio for mortality, (HR = 2.08, [1.97, 2.29], P < .001). Of those that deferred, 1250 (57.6%) received postdeferral radiation. Compared to White patients, Black patients had OR of 1.82 for deferring both surgery and radiation (aOR: 1.82, [1.31, 2.53], P < .001) and Asian and Pacific Island (API) patients had an OR of 2.67 (aOR: 2.67, [1.27, 4.64], P = .008). Other predictors of deferral of therapy included: Medicare or lack of insurance, and treatment at nonacademic medical centers.
Insurance status and Black race, and API race are associated with deferring surgical therapy and radiation therapy for NSCLC. These findings are consistent with the large body of work showing worse outcomes for treatment of NSCLC in minority patients.
非小细胞肺癌（NSCLC）的治疗仍存在明显的种族相关差异。早期疾病手术管理的延迟被认为是造成这种差异的原因。黑种人被认为更有可能推迟手术治疗。目前尚不清楚种族如何影响 NSCLC 手术治疗后接受放射治疗的可能性。
使用 2004 年至 2015 年期间接受手术切除的 I 期 NSCLC 患者的国家癌症数据库（NCBD）数据，对 18 岁及以上的患者进行了回顾性队列分析（N=89462）。多变量逻辑回归确定了手术延迟的预测因素和手术延迟后放射治疗延迟的预测因素。进行 Kaplan-Meier 生存分析、对数秩检验和多变量 Cox 比例风险回归。
87293（97.6%）名患者接受了手术，2169（2.4%）名患者被推迟。推迟的患者死亡风险比（HR）更高，为 2.1 倍（HR=2.08，[1.97，2.29]，P<0.001）。在推迟治疗的患者中，有 1250 名（57.6%）接受了术后放射治疗。与白人患者相比，黑人患者同时推迟手术和放射治疗的比值比（OR）为 1.82（aOR：1.82，[1.31，2.53]，P<0.001），亚洲和太平洋岛民（API）患者的 OR 为 2.67（aOR：2.67，[1.27，4.64]，P=0.008）。其他治疗延迟的预测因素包括：医疗保险或无保险以及在非学术医疗中心治疗。
保险状况和黑种人以及 API 种族与 NSCLC 手术治疗和放射治疗的延迟有关。这些发现与大量表明少数族裔患者 NSCLC 治疗结果较差的工作一致。
