Impact of race on outcomes of patients with non-small cell lung cancer

Objective: Examination of factors that may contribute to racial disparity among those with lung cancer has been thwarted by heterogeneous treatment and staging strategies, limited national registry and socioeconomic and follow-up data. This study examines a decades worth of data to better elucidate these factors in a cohort staged or treated using homogeneous algorithms. Methods: A nested case-control study of patients with non-small cell lung cancer (NSCLC). White patients were matched 4:1 to African American patients on age, gender, comorbidities, performance status, and stage. All patients underwent clinical and pathologic staging by one physician using similar staged-based treatment algorithms. Socioeconomic status was assessed by annual income per capita, insurance status, and education level. The primary outcome was survival rate. Results: Among the 930 patients in this series, African Americans were more likely to be smokers (p < 0.001), have a lower per-capita annual income (p = 0.016), greater delay to treatment (p = 0.023), and less likely to agree to neo-adjuvant therapy (p < 0.001). Whites had better 5-year overall survival than African Americans for stage I (84% versus 78%, p = 0.037), stage II (52% versus 44%, p = 0.041), and stage III (32% versus 20%, p = 0.008) NSCLC. However, this survival advantage disappeared for earlier stages of NSCLC (I and 11) when adjusted for socioeconomic status and smoking status. The survival advantage for stage IIIa was lost when adjusted for neo-adjuvant chemoradiotherapy. African American men had the worst survival of all subgroups independent of socioeconomic status. Conclusions: Given uniform staging, treatment, and socioeconomic status the overall survival rates for African American and White patients with NSLC are similar.