In recent decades, persistent disparities in the survival of individuals with early-stage non-small cell lung cancer (NSCLC) have been observed between black and white patients. The impact of curative-intent surgery and/or stereotactic body radiation therapy (SBRT) on this disparity remains uncertain. A study investigated the influence of race/ethnicity and curative-intent treatment (surgery and/or SBRT) on mortality outcomes among patients with early-stage NSCLC. The study utilized population-based data from Florida, the third-largest state in the US and the second-highest in terms of annual diagnosed cancer cases.
The study analyzed data from the Florida Cancer Data System (FCDS) covering the period from 2007 to 2018 to assess cancer-specific mortality rates among different racial and ethnic groups, including non-Hispanic blacks (NHB), Hispanics, Asian/Pacific Islanders (API), and non-Hispanic whites (NHW). To enhance the analysis, the FCDS data was linked with discharge data, resulting in a high match rate of 94%. This linkage provided valuable patient-level information on comorbidities and specific treatments received. Multivariable Cox proportional hazards regression models examined the relationship between race/ethnicity, curative-intent treatment, and lung cancer-specific mortality (LCSM). Furthermore, a competing risk analysis was conducted to account for deaths caused by other factors in relation to LCSM. The study included 63,872 patients with early-stage NSCLC and investigated the impact of race/ethnicity and curative-intent treatment on lung cancer-specific survival. The patient population comprised 83.2% non-Hispanic whites (NHW), 6.6% non-Hispanic blacks (NHB), 8.7% Hispanics, 0.77% Asian/Pacific Islanders (API), and 0.79% from other racial backgrounds. Among these patients, 72.2% received curative-intent treatment, which included surgery and/or SBRT. All patients’ median lung cancer-specific survival time was 5.43 years (95% CI, 5.30-5.56). After adjusting for clinical and sociodemographic factors, including the stage at diagnosis and comorbidities, race/ethnicity and curative-intent treatment were found to impact LCSM independently. Specifically, NHB patients had a slightly higher risk of LCSM than NHW patients, with a hazard ratio (HR) of 1.06 (95% CI, 1.00-1.11). Patients treated with SBRT had a higher risk of LCSM compared to those who underwent curative-intent surgery, with an HR of 1.87 (95% CI, 1.78-1.97). However, when considering the combined effect of race/ethnicity and curative-intent treatment in a fully adjusted model, NHB patients who received curative-intent treatment exhibited nearly identical survival rates as NHW patients, with an HR of 0.95 (95% CI, 0.87-1.03). These findings were consistent when conducting a competing risk analysis, with a subdistribution hazard ratio (sHR) of 0.97 (95% CI, 0.89-1.02).
The study showed that curative-intent treatment is linked to similar survival rates between NHB and NHW patients in a racially diverse population. It highlighted the importance of considering the specific type of curative-intent treatment rather than general surgery or radiotherapy when addressing racial and ethnic disparities in survival. To improve outcomes for all early-stage NSCLC patients, efforts should focus on increasing the use of curative-intent surgery and SBRT, currently at 56.5% and 9.4% utilization rates, respectively.
