Curative-intent therapy in patients with early non-small cell lung cancer resulted in “nearly identical survival” for Black and White individuals.

Curative-intent treatment for early-stage non-small cell lung cancer (NSCLC) yielded comparable survival rates in non-Hispanic Black and non-Hispanic White individuals, according to findings presented at the 2023 ASCO Annual Meeting.

“Racial disparities in early-stage NSCLC survival have persisted between [Black patients] and [White patients] in the past few decades,” Paulo S. Pinheiro, PhD, and colleagues wrote. “The role of receipt of curative-intent surgery and/or stereotactic body radiation therapy (SBRT) in this disparity is unclear.”

To investigate this question, Dr. Pinheiro and colleagues assessed associations of race/ethnicity and curative-intent treatment (surgery and/or SRBT) with mortality among individuals with early-stage NSCLC using population-based data from Florida, “the third largest state in the US and the second state in the number of cancer cases diagnosed annually,” according to the study results.

The researchers examined all patients in the state with a diagnosis between 2007 and 2018 according to racial/ethnic group: non-Hispanic Black (NHB), Hispanic, Asian/Pacific Islander (API), and non-Hispanic White (NHW). Multivariable Cox proportional hazards regression models were used to examine the association of race/ethnicity and curative-intent treatment with lung cancer-specific mortality.

“Nearly Identical Survival” for Black & White Patients

The analysis included data from 63,872 patients with early-stage NSCLC (83.2% NHW; 8.7% Hispanic; 6.6% NHB; 0.79% other races; and 0.77% API). Most patients (72.2%) received curative-intent therapy in the form of surgery or SRBT, or both. Median lung cancer-specific survival for all patients was 5.43 years.

After inclusion of all clinical and sociodemographic factors, such as stage at diagnosis and comorbidities, race/ethnicity (NHB vs NHW: HR, 1.06; 95% CI, 1.00-1.11) and curative-intent treatment (SBRT vs surgery: HR, 1.87; 95% CI, 1.78-1.97) were independently associated with lung cancer-specific mortality. However, after combining the effect of race/ethnicity and curative-intent treatment in the fully adjusted model, NHB patients who received curative-intent therapy had “nearly identical survival” compared with NHW patients (HR, 0.95; 95% CI, 0.87-1.03), according to the study results. Similar findings were seen in a competing risk analysis (subdistribution HR, 0.97; 95% CI, 0.89-1.02).

“The results underscore the importance of considering receipt of (specifically) curative-intent treatment rather than receipt of any form of surgery or radiotherapy in racial/ethnic survival disparities,” Dr. Pinheiro and colleagues wrote. “The uptake of curative-intent surgery and SBRT, which currently stands at 56.5% and 9.4%, respectively, should be increased to improve survival outcomes for early-stage NSCLC for all.”

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