Department of Medical Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
J Natl Cancer Inst. 2024 Oct 1;116(10):1697-1704. doi: 10.1093/jnci/djae118.
Immune checkpoint inhibitors have profoundly impacted survival among patients with metastatic non-small cell lung cancer. However, population-based studies evaluating this impact on survival by race and socioeconomic factors are lacking.
We used the Surveillance, Epidemiology, and End Results Program-Medicare database to identify patients with metastatic non-small cell lung cancer diagnosed between 2015 and 2019. The primary study outcomes were the receipt of an immune checkpoint inhibitor and overall survival. χ2 tests and logistic regression were used to identify demographic factors associated with receipt of immune checkpoint inhibitors. The Kaplan-Meier method was used to calculate 2-year overall survival rates, and log-rank tests were used to compare survival by race and ethnicity.
Of 17 134 patients, approximately 39% received an immune checkpoint inhibitor. Those diagnosed with cancer recently (in 2019); who are relatively younger (aged younger than 85 years); non-Hispanic White, non-Hispanic Asian, or Hispanic; living in high socioeconomic status or metropolitan areas; not Medicaid eligible; and with adenocarcinoma histology were more likely to receive immune checkpoint inhibitors. The 2-year overall survival rate from diagnosis was 21% for the overall population. The 2-year overall survival rate from immune checkpoint inhibitor initiation was 30%, among those who received at least 1 cycle and 11% among those who did not receive immune checkpoint inhibitors. The 2-year overall survival rates were higher among non-Hispanic White (22%) and non-Hispanic Asian (23%) patients compared with non-Hispanic Black (15%) and Hispanic (17%) patients. There was no statistically significant racial differences in survival for those who received immune checkpoint inhibitors.
Immune checkpoint inhibitor utilization rates and the resulting outcomes were inferior for certain vulnerable groups, mandating the need for strategies to improve access to care.
免疫检查点抑制剂显著改善了转移性非小细胞肺癌患者的生存。然而，缺乏基于人群的研究来评估种族和社会经济因素对生存的影响。
我们使用监测、流行病学和最终结果计划-医疗保险数据库，确定了 2015 年至 2019 年间诊断为转移性非小细胞肺癌的患者。主要研究结果是接受免疫检查点抑制剂和总体生存。采用 χ2 检验和逻辑回归分析确定与接受免疫检查点抑制剂相关的人口统计学因素。采用 Kaplan-Meier 法计算 2 年总生存率，并采用对数秩检验比较不同种族和族裔的生存情况。
在 17134 名患者中，约 39%接受了免疫检查点抑制剂治疗。最近（2019 年）诊断出癌症的患者；年龄相对较轻（<85 岁）；非西班牙裔白人、非西班牙裔亚裔或西班牙裔；生活在高社会经济地位或大都市区；不符合医疗补助资格；且组织学为腺癌的患者更有可能接受免疫检查点抑制剂治疗。总体人群的诊断后 2 年总生存率为 21%。在至少接受 1 个周期免疫检查点抑制剂治疗的患者中，2 年总生存率为 30%，而未接受免疫检查点抑制剂治疗的患者中，2 年总生存率为 11%。与非西班牙裔黑人（15%）和西班牙裔（17%）患者相比，非西班牙裔白人（22%）和非西班牙裔亚裔（23%）患者的 2 年总生存率更高。接受免疫检查点抑制剂治疗的患者在生存方面没有统计学上的种族差异。
某些弱势群体接受免疫检查点抑制剂的比例和治疗结果较差，这需要制定策略来改善获得治疗的机会。
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