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Hong JH, Swami N, Dee EC, Gomez SL, Lam MB. Non-small cell lung cancer disparities in stage at presentation and treatment for Asian American, Native Hawaiian, and Pacific Islander women. J Surg Oncol 2023; 127:882-890. [PMID: 36719164 DOI: 10.1002/jso.27204] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) represent the fastest-growing group in the United States. While described in aggregate, great variations exist within the community. We aimed to determine whether there were differences in stage at presentation and treatment status among AANHPI women with non-small cell lung cancer (NSCLC). METHODS Between 2004 and 2016, we identified 522 361 female patients with newly diagnosed NSCLC from the National Cancer Database. Multivariable logistic regression models were used to define adjusted odds ratios (aORs) of presenting with stage IV disease and not receiving treatment. RESULTS AANHPI women were more likely to present with stage IV disease compared to White (54.32% vs. 40.28%, p < 0.001). Aside from Hawaiian, Pakistani, and Hmong women, all other ethnic groups had greater odds of presenting with stage IV disease than White women. AANHPI women <65 years were more likely to present with stage IV disease (p = 0.030). Only Vietnamese women showed a significant difference (aOR = 1.30 [1.06-1.58], p = 0.010) for likelihood of receiving treatment compared to White. CONCLUSIONS Differences in stage at presentation and treatment status in women with NSCLC were observed among AANHPI ethnic groups when populations were disaggregated.
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Affiliation(s)
- Ji Hyun Hong
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nishwant Swami
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology & Biostatistics and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Patel PB, Alpert N, Taioli E, Flores R. Disparities in clinical and demographic characteristics among Asian/Pacific Islander and Non-Hispanic White newly diagnosed lung cancer patients. Cancer Causes Control 2022; 33:547-557. [PMID: 35043281 DOI: 10.1007/s10552-021-01548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Racial disparities persist among lung cancer patients but have not been adequately studied among Asian/Pacific Islander (API) subgroups, which are heterogeneous. This study compared clinical and demographic characteristics at diagnosis of API subgroups and NHW patients. METHODS NHW and API adults diagnosed with lung cancer were identified from the Surveillance, Epidemiology, and End Results database (1990-2015). API was divided into eight subgroups: Chinese, Japanese, Filipino, Hawaiian/Pacific Islander, Korean, Vietnamese, Asian Indian/Pakistani, and Other. Multivariable multinomial logistic regression models were used to assess adjusted associations of clinical and demographic factors with API/subgroups. RESULTS There were 522,702 (92.6%) NHW and 41,479 (7.4%) API lung cancer patients. API were less likely to be diagnosed at the age of ≥ 80 years (ORadj 0.53, 95% CI 0.48-0.58 for ≥ 80 vs. ≤ 39 years) than NHW. However, Japanese patients were more often diagnosed at ≥ 80 years compared to other ethnic subgroups. API were less often female (ORadj 0.85, 95% CI 0.83-0.86), and unmarried (ORadj 0.71, 95% CI 0.68-0.74); however, among API, Japanese, Hawaiian/Pacific Islander, Korean, and Vietnamese were more often unmarried, compared to Chinese patients. API were more frequently diagnosed at stage IV, compared to stage I (ORadj 1.31, 95% CI 1.27-1.35). API had significantly less squamous cell carcinoma (ORadj 0.54, 95% CI 0.52-0.56, compared to adenocarcinoma); among API, Japanese, Filipino, Hawaiian/Pacific Islander, Korean, Asian Indian/Pakistani, and Other were more likely than Chinese patients to present with squamous cell histology (range: ORadj[Other] 1.24, 95% CI 1.09-1.41; ORadj[Hawaiian/Pacific Islander] 2.47, 95% CI 2.22-2.75). CONCLUSION At diagnosis, there are significant differences in demographic and clinical characteristics between NHW, API, and API subgroups. Treating API patients as a single population may overlook biological, environmental, and behavioral differences that might be beneficial in designing prevention strategies and treatment.
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Affiliation(s)
- Parth B Patel
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naomi Alpert
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Alwatari Y, Sabra MJ, Khoraki J, Ayalew D, Wolfe LG, Cassano AD, Shah RD. Does Race or Ethnicity Impact Complications After Pulmonary Lobectomy for Patients With Lung Cancer? J Surg Res 2021; 262:165-174. [PMID: 33582597 DOI: 10.1016/j.jss.2021.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/28/2020] [Accepted: 01/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Racial disparity in surgical access and postoperative outcomes after pulmonary lobectomy continues to be a concern and target for improvement; however, evidence of independent impact of race on complications is lacking. The objective of this study was to investigate the impact of race/ethnicity on surgical outcomes after lobectomy for lung cancer and estimate the distribution of racial/ethnic groups among expected resectable lung cancer cases using a large national database. METHODS Patients who underwent lobectomy for lung cancer between 2005 and 2016 were identified in the American College of Surgeon National Surgical Quality Improvement Program. Preoperative characteristics and postoperative outcomes were compared between race/ethnicity groups in all patients and in propensity-matched cohorts, controlling for pertinent risk factors. Distribution of each race/ethnicity in the database was calculated relative to estimated numbers of patients with resectable lung cancer in the United States. RESULTS A total of 10,202 patients (age 67.6 ± 9.7, 46.7% male, 86.4% white) underwent nonemergent lobectomy (46.8% thoracoscopic). Blacks had higher rates of baseline risk factors. In propensity score-matched cohorts of whites, blacks, and Hispanics/Asians (n = 498 each), postoperatively, blacks had higher rates of prolonged intubation and longer hospital stay while whites had a higher rate of pneumonia. Race was independently associated with these adverse outcomes on multivariate analysis. Proportion of blacks and Hispanics in the American College of Surgeon National Surgical Quality Improvement Program was lower than their respective proportion of resectable lung cancer in the United States. CONCLUSIONS In a large national-level surgical database, there was lower than expected representation of black and Hispanic patients. Black race was independently associated with extended length of stay and prolonged intubation, whereas white was independently associated with postoperative pneumonia.
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Affiliation(s)
- Yahya Alwatari
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia.
| | - Michel J Sabra
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Jad Khoraki
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Dawit Ayalew
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Luke G Wolfe
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Anthony D Cassano
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Rachit D Shah
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
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Toubat O, Farias AJ, Atay SM, McFadden PM, Kim AW, David EA. Disparities in the surgical management of early stage non-small cell lung cancer: how far have we come? J Thorac Dis 2019; 11:S596-S611. [PMID: 31032078 DOI: 10.21037/jtd.2019.01.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
It is currently estimated that nearly one-third of patients with newly diagnosed non-small cell lung cancer (NSCLC) have stage I-II disease on clinical evaluation. Curative-intent surgical resection has been a cornerstone of the therapeutic management of such patients, offering the best clinical and oncologic outcomes in the long-term. In 1999, Peter Bach and colleagues brought attention to racial disparities in the receipt of curative-intent surgery in the NSCLC population. In the time since this seminal study, there is accumulating evidence to suggest that disparities in the receipt of definitive surgery continue to persist for patients with early stage NSCLC. In this review, we sought to provide an up-to-date assessment of 20 years of surgical disparities literature in the NSCLC population. We summarized common and unrecognized disparities in the receipt of surgical resection for early stage NSCLC and demonstrated that demographic and socioeconomic factors such as race/ethnicity, special patient groups, income and insurance continue to impact the receipt of definitive resection. Additionally, we found that discrepancies in patient and provider perceptions of and attitudes toward surgery, access to invasive staging, distance to treatment centers and negative stigmas about lung cancer that patients experience may act to perpetuate disparities in surgical treatment of early stage lung cancer.
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Affiliation(s)
- Omar Toubat
- Keck School of Medicine of USC, Los Angeles, CA, USA.,Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Scott M Atay
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - P Michael McFadden
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Elizabeth A David
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
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Yang H, Li X, Shi J, Fu H, Yang H, Liang Z, Xiong H, Wang H. A nomogram to predict prognosis in patients undergoing sublobar resection for stage IA non-small-cell lung cancer. Cancer Manag Res 2018; 10:6611-6626. [PMID: 30584357 PMCID: PMC6284539 DOI: 10.2147/cmar.s182458] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction This study aimed to develop a practical nomogram to predict prognosis in patients who are undergoing sublobar resection for stage IA non-small-cell lung cancer (NSCLC). Data from Surveillance, Epidemiology, and End Results (SEER) databases were used to construct the nomogram. Methods Data from patients undergoing sublobar resection for stage IA NSCLC diagnosed between 2004 and 2014 were extracted from the SEER database. Factors that may predict the outcome were identified using the Kaplan–Meier method and the Cox proportional-hazards model. A nomogram was constructed to predict the 3- and 5-year overall survival (OS) and lung cancer-specific survival (LCSS) rates of these patients. The predictive accuracy of the nomogram was measured using the concordance index (C-index) and calibration curve. Results A total of 4,866 patients were selected for this study. Using univariate and multivariate analyses, eight independent prognostic factors associated with OS were identified, including sex (P<0.001), age (P<0.001), race (P=0.043), marital status (P=0.009), pathology (P=0.004), differentiation (P<0.001), tumor size (P<0.001), and surgery (P=0.001), and five independent prognostic factors associated with LCSS were also identified, including sex (P<0.001), age (P<0.001), differentiation (P<0.001), tumor size (P<0.001), and surgery (P=0.011). A nomogram was established based on these results and validated using the internal bootstrap resampling method. The C-index of the established nomogram for OS and LCSS was 0.649 (95% CI: 0.635–0.663) and 0.640 (95% CI: 0.622–0.658), respectively. The calibration curves for probability of 3-, and 5-year OS and LCSS rates demonstrated good agreement between the nomogram prediction and actual observation. Conclusion This innovative nomogram delivered a relatively accurate individual prognostic prediction for patients undergoing sublobar resection for stage IA NSCLC.
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Affiliation(s)
- Heli Yang
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Haidian, Beijing, People's Republic of China
| | - Xiangdong Li
- Department of Cardiothoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, People's Republic of China
| | - Jialun Shi
- Department of Cardiothoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, People's Republic of China
| | - Hao Fu
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Haidian, Beijing, People's Republic of China
| | - Hao Yang
- Department of Cardiothoracic Surgery, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, People's Republic of China
| | - Zhen Liang
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Haidian, Beijing, People's Republic of China
| | - Hongchao Xiong
- Department of Thoracic Surgery I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Haidian, Beijing, People's Republic of China
| | - Hui Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China,
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Wu Y, Ai Z, Xu G. Marital status and survival in patients with non-small cell lung cancer: an analysis of 70006 patients in the SEER database. Oncotarget 2017; 8:103518-103534. [PMID: 29262581 PMCID: PMC5732747 DOI: 10.18632/oncotarget.21568] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/20/2017] [Indexed: 12/18/2022] Open
Abstract
Marital status has been demonstrated to be related to the survival of patients in various cancer types, but the relationship in the large population of non-small cell lung cancer (NSCLC) has rarely been studied. In this study, we retrospectively extracted 70006 eligible NSCLC patients from the Surveillance, Epidemiology, and End Results (SEER) database in the period from 2004 to 2012. Marital status was categorized as married, divorced/separated, widowed, and never married. Chi-square tests were used to investigate the association between marital status and other variables. The Kaplan-Meier test was adopted to compare survival curves of different groups. Multivariate Cox regression analyses were conducted to estimate the effect of marital status on overall survival (OS) and NSCLC cause-specific survival (CSS). We further performed subgroup analyses according to TNM stage and surgery condition. The results showed that marital status was an independent prognostic factor for OS and CSS of NSCLC patients. Subgroup analyses showed that the relationship between marital status and prognosis varies according to different conditions. Widowed patients with surgery were at greater risk of death across all stages and non-surgical unmarried patients at advanced stages suffered poorer prognosis than the married. To conclude, in the NSCLC patients, married patients had advantage over the unmarried in both OS and CSS.
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Affiliation(s)
- Ying Wu
- Postdoctoral Research Station of Medicine, Tongji University School of Medicine, Shanghai, China
| | - Zisheng Ai
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China
| | - Guotong Xu
- Tongji Eye Institute, Tongji University School of Medicine, Shanghai, China
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Li D, Du XL, Ren Y, Liu P, Li S, Yang J, Lv M, Chen L, Wang X, Li E, Yang J, Yi M. Comparative Analysis of Clinicopathologic Features of, Treatment in, and Survival of Americans with Lung or Bronchial Cancer. PLoS One 2016; 11:e0156617. [PMID: 27244238 PMCID: PMC4886968 DOI: 10.1371/journal.pone.0156617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/17/2016] [Indexed: 01/12/2023] Open
Abstract
Ethnic disparities in lung and bronchial cancer diagnoses and disease-specific survival (DSS) rates in the United States are well known. However, few studies have specifically assessed these differences in Asian subgroups. The primary objectives of the retrospective analysis described herein were to identify any significant differences in clinicopathologic features, treatment, and survival rate between Asian lung cancer patients and lung cancer patients in other broad ethnic groups in the United States and to determine the reasons for these differences among subgroups of Asian patients with lung or bronchial cancer. We searched the Surveillance, Epidemiology, and End Results Program database to identify patients diagnosed with lung or bronchial cancer from 1990 to 2012. Differences in clinicopathologic features, treatment, and DSS rate in four broad ethnic groups and eight Asian subgroups were compared. The study population consisted of 849,088 patients, 5.2% of whom were of Asian descent. Female Asian patients had the lowest lung and bronchial cancer incidence rates, whereas male black patients had the highest rates. Asian patients had the best 5-year DSS rate. In our Asian subgroup analysis, Indian/Pakistani patients had the best 5-year DSS rate, whereas Hawaiian/Pacific Islander patients had the worst 5-year DSS rates. We found the differences in DSS rate among the four broad ethnic groups and eight Asian subgroups when we grouped patients by age and disease stage, as well. Asian patients had better DSS rates than those in the other three broad ethnic groups in almost every age and disease-stage group, especially in older patients and those with advanced-stage disease. In conclusion, we found that clinicopathologic features and treatment of lung and bronchial cancer differ by ethnicity in the United States, and the differences impact survival in each ethnic group.
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Affiliation(s)
- Dan Li
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xianglin L. Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, United States of America
| | - Yinghong Ren
- Department of Internal Medicine, Shangluo Central Hospital, Shangluo, Shaanxi, China
| | - Peijun Liu
- Department of Translational Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Shuting Li
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jiao Yang
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Meng Lv
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Ling Chen
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xin Wang
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Enxiao Li
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jin Yang
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- * E-mail: (MY); (Jin Yang)
| | - Min Yi
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail: (MY); (Jin Yang)
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