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Costa PA, Saul EE, Paul Y, Iyer S, da Silva LL, Tamariz L, Lopes G. Prevalence of Targetable Mutations in Black Patients With Lung Cancer: A Systematic Review and Meta-Analysis. JCO Oncol Pract 2021; 17:e629-e636. [PMID: 33974815 DOI: 10.1200/op.20.00961] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
PURPOSE Inferior outcomes of Black patients with lung cancer compared with other racial groups are often linked to socioeconomic factors. It is crucial to determine whether a varying prevalence of targetable mutations limits treatments and contributes to disparities. MATERIALS AND METHODS We conducted a meta-analysis on the prevalence of lung cancer EGFR, ALK, ROS-1, and BRAF mutations in Black patients compared with White, Hispanic, and Asian patients. We searched PubMed/MEDLINE, Cochrane Library, EMBASE, CENTRAL, Google Scholar, and clinicaltrials.gov databases. We selected studies reporting the prevalence of at least one mutation in the Black population. We calculated the pooled prevalence of mutations using fixed effects, exact binomial distributions, and Freeman-Turkey double arcsine transformation to stabilize the variances. RESULTS Twenty studies with 11,867 patients were included. In Black patients, EGFR was the most prevalent mutation (6%; 95% CI, 5 to 7), followed by BRAF (1%; 95% CI, 0 to 2), ALK (1%; 95% CI, 0 to 2), and ROS-1 (0%; 95% CI, 0 to 1). Black patients had a lower prevalence of EGFR mutations than White, Hispanic, and Asian patients (P < .01). BRAF mutations were less prevalent in Black compared with White patients (P < .05), and ALK mutations were less prevalent when compared with Hispanic patients (P < .05). CONCLUSION EGFR is the most frequent mutation found in Black patients, although its prevalence is lower than that in other races. Black patients have a low overall prevalence of ALK, ROS-1, and BRAF mutations. Given that disproportional eligibility for targeted therapies may be contributing to inferior outcomes, research focused on the Black population is needed to evaluate specific tumor characteristics and therapeutic strategies.
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Affiliation(s)
- Philippos A Costa
- Division of Internal Medicine, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL
| | - Eduardo E Saul
- Division of Internal Medicine, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL
| | - Yonette Paul
- Division of Hematology and Medical Oncology, Department of Medicine, Miller School of Medicine, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Sunil Iyer
- Division of Hematology and Medical Oncology, Department of Medicine, Miller School of Medicine, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Laercio Lopes da Silva
- Division of Internal Medicine, Department of Medicine, Metrowest Medical Center/Tufts University School of Medicine, Framingham, MA
| | - Leonardo Tamariz
- Division of Population Health and Computational Medicine, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL
| | - Gilberto Lopes
- Division of Hematology and Medical Oncology, Department of Medicine, Miller School of Medicine, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
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St Helen G, Benowitz NL, Ko J, Jacob P, Gregorich SE, Pérez-Stable EJ, Murphy SE, Hecht SS, Hatsukami DK, Donny EC. Differences in exposure to toxic and/or carcinogenic volatile organic compounds between Black and White cigarette smokers. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:211-223. [PMID: 31406274 PMCID: PMC7012700 DOI: 10.1038/s41370-019-0159-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/23/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVE It is unclear why Black smokers in the United States have elevated risk of some tobacco-related diseases compared to White smokers. One possible causal mechanism is differential intake of tobacco toxicants, but results across studies are inconsistent. Thus, we examined racial differences in biomarkers of toxic volatile organic compounds (VOCs) present in tobacco smoke. METHOD We analyzed baseline data collected from 182 Black and 184 White adult smokers who participated in a randomized clinical trial in 2013-2014 at 10 sites across the United States. We examined differences in urinary levels of ten VOC metabolites, total nicotine equivalents (TNE), and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), controlling for covariates such as cigarettes per day (CPD), as well as differences in VOCs per TNE to assess the extent to which tobacco exposure, and not metabolic factors, accounted for racial differences. RESULTS Concentration of metabolites of acrolein, acrylonitrile, ethylene oxide, and methylating agents were significantly higher in Blacks compared to Whites when controlled for covariates. Other than the metabolite of methylating agents, VOCs per TNE did not differ between Blacks and Whites. Concentrations of TNE/CPD and VOCs/CPD were significantly higher in Blacks. Menthol did not contribute to racial differences in VOC levels. CONCLUSIONS For a given level of CPD, Black smokers likely take in higher levels of acrolein, acrylonitrile, and ethylene oxide than White smokers. Our findings are consistent with Blacks taking in more nicotine and toxicants per cigarette smoked, which may explain their elevated disease risk relative to other racial groups.
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Affiliation(s)
- Gideon St Helen
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA.
- Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, CA, USA.
| | - Neal L Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
- Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Jennifer Ko
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
| | - Peyton Jacob
- Clinical Pharmacology Research Program, Division of Cardiology, Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
- Center for Tobacco Control Research and Education (CTCRE), University of California, San Francisco, CA, USA
| | - Steven E Gregorich
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute and Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Dorothy K Hatsukami
- Masonic Cancer Center, Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Long-Term Survival of Patients with Metastatic Non-Small-Cell Lung Cancer over Five Decades. JOURNAL OF ONCOLOGY 2021; 2021:7836264. [PMID: 33519934 PMCID: PMC7817269 DOI: 10.1155/2021/7836264] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/05/2020] [Accepted: 12/14/2020] [Indexed: 12/25/2022]
Abstract
Objective Novel therapeutics and supportive care improved outcomes for metastatic non-small-cell lung cancer (mNSCLC) patients. Major advances over the past five decades include the introduction of combination chemotherapy, small molecules targeting mutant proteins, especially EGFR, and more recently immunotherapy. We aim to document real-world long-term survival over the past five decades. Methods Survival statistics were extracted from the Survival, Epidemiology, and End Results (SEER) database for mNSCLC patients during 1973-2015. Two- and five-year survival (2yS and 5yS) were analyzed using Kaplan-Meier and proportional hazard models. Results The study population consisted of 280,655mNSCLC patients diagnosed during 1973-2015. Longer survival was seen in younger, female, married, Asian/Pacific Islander race, adenocarcinoma, lower grade, more recent diagnosis, higher income, and chemotherapy-treated patients. 2yS increased during the study period from 2.6% to 12.9%, and 5yS increased from 0.7% to 3.2%. 2yS of patients <50 years of age rose from 2.1% to 22.8%, and their 5yS rose from 0.7% to 6.2%. 2yS of adenocarcinoma patients improved from 2.7% to 16.2%, and their improved 5yS from 1.1% to 3.9%. Conclusions Between 1973 and 2015, there was a dramatic improvement in long-term survival, with an approximately five-fold increase in both 2yS and 5yS. Nonetheless, absolute numbers of long-term survivors remained low, with less than 4% living 5 years. This provides a baseline to compare long-term outcomes seen in the current generation of clinical trials.
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Zhou K, Shi H, Chen R, Cochuyt JJ, Hodge DO, Manochakian R, Zhao Y, Ailawadhi S, Lou Y. Association of Race, Socioeconomic Factors, and Treatment Characteristics With Overall Survival in Patients With Limited-Stage Small Cell Lung Cancer. JAMA Netw Open 2021; 4:e2032276. [PMID: 33433596 PMCID: PMC7804918 DOI: 10.1001/jamanetworkopen.2020.32276] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE It has been established that disparities in race and socioeconomic status are associated with outcomes of non-small cell lung cancer. However, it remains unknown whether this extends to stage I, II, or III small cell lung cancer (SCLC), or limited-stage SCLC (L-SCLC). OBJECTIVE To investigate the associations of race, socioeconomic factors, and treatment characteristics with survival among patients with L-SCLC. DESIGN, SETTING, AND PARTICIPANTS Demographic information for patients with L-SCLC diagnosed between 2004 and 2014 was obtained from the National Cancer Database. The follow-up end point is death or last follow-up (date of last contact). Patients were divided into 5 mutually exclusive cohorts by race. Data analysis was performed in October 2019. MAIN OUTCOMES AND MEASURES Cox proportional hazards models were used to calculate univariable and multivariable models. Multivariable analyses were conducted to assess the associations of race and socioeconomic factors with risk-adjusted outcomes. Overall survival between groups was depicted by Kaplan-Meier curves. RESULTS Of 72 409 patients analyzed (median [range] age, 67.0 [23.0-90.0] years), 40 289 (55.6%) were women. The distribution of disease stage was 10 619 patients (14.7%) with stage I disease, 7689 patients (10.6%) with stage II disease, and 54 101 patients (74.7%) with stage III disease. The median (range) duration of follow-up was 8.2 (2.4-15.8) months. Compared with White patients, the hazard of death decreased to 0.92 (95% CI, 0.89-0.95; P < .001) for African American patients and 0.83 (95% CI, 0.77-0.91; P < .001) for Asian patients. The difference in median survival among different racial groups was significant only among those with stage III SCLC. Other factors associated with better survival were female sex, high income, high education, private insurance, diagnostic confirmation by positive cytological analysis, increase in number of sampled regional lymph nodes, and earlier stage at diagnosis. CONCLUSIONS AND RELEVANCE This analysis highlights disparities in race and socioeconomic factors associated with outcomes of L-SCLC. Racial minorities, including African American and Asian patients, have better survival than White patients for L-SCLC after adjustment for sociodemographic factors.
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Affiliation(s)
- Kexun Zhou
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Huashan Shi
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Ruqin Chen
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Jordan J. Cochuyt
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - David O. Hodge
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - Rami Manochakian
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Yujie Zhao
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Sikander Ailawadhi
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Yanyan Lou
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, Florida
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Nardi EA, Sun CL, Robert F, Wolfson JA. Lung Cancer in Nonelderly Patients: Facility and Patient Characteristics Associated With Not Receiving Treatment. J Natl Compr Canc Netw 2019; 17:931-939. [DOI: 10.6004/jnccn.2019.7294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/08/2019] [Indexed: 11/17/2022]
Abstract
Background: In elderly patients with lung cancer, race/ethnicity is associated with not receiving treatment; however, little attention has been given to nonelderly patients (aged ≤65 years) with a range of disease stages and histologies. Nonelderly patients with lung cancer have superior survival at NCI-designated Comprehensive Cancer Centers (CCCs), although the reasons remain unknown. Patients and Methods: A retrospective cohort study was conducted in 9,877 patients newly diagnosed with small cell or non–small cell lung cancer (all stages) between ages 22 and 65 years and reported to the Los Angeles County Cancer Surveillance Program registry between 1998 and 2008. Multivariable logistic regression examined factors associated with nontreatment. Results: In multivariable analysis, race/ethnicity was associated with not receiving cancer treatment (black: odds ratio [OR], 1.22; P=.004; Hispanic: OR, 1.17; P=.04), adjusting for patient age, sex, disease stage, histology, diagnosis year, distance to treatment facility, type of facility (CCC vs non-CCC), and insurance status. With inclusion of socioeconomic status (SES) in the model, the effect of race/ethnicity was no longer significant (black: OR, 1.02; P=.80; Hispanic: OR, 1.00; P=1.00). Factors independently associated with nontreatment included low SES (OR range, 1.37–2.15; P<.001), lack of private insurance (public: OR, 1.71; P<.001; uninsured: OR, 1.30; P<.001), and treatment facility (non-CCC: OR, 3.22; P<.001). Conclusions: In nonelderly patients with lung cancer, SES was associated with nontreatment, mitigating the effect of race/ethnicity. Patients were also at higher odds of nontreatment if they did not have private insurance or received cancer care at a non-CCC facility. These findings highlight the importance of understanding how both patient-level factors (eg, SES, insurance status) and facility-level factors (eg, treatment facility) serve as barriers to treatment of nonelderly patients with lung cancer.
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Affiliation(s)
- Elizabeth A. Nardi
- aNational Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
- bDivision of Pediatric Hematology-Oncology, Institute for Cancer Outcomes and Survivorship, O’Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama
| | - Can-Lan Sun
- cDepartment of Population Sciences, City of Hope National Medical Center, Duarte, California; and
| | - Francisco Robert
- dDivision of Hematology-Oncology, O’Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama
| | - Julie A. Wolfson
- bDivision of Pediatric Hematology-Oncology, Institute for Cancer Outcomes and Survivorship, O’Neal Comprehensive Cancer Center at UAB, Birmingham, Alabama
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Osuoha CA, Callahan KE, Ponce CP, Pinheiro PS. Disparities in lung cancer survival and receipt of surgical treatment. Lung Cancer 2018; 122:54-59. [DOI: 10.1016/j.lungcan.2018.05.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 12/17/2022]
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Shewale JB, Nelson DB, Rice DC, Sepesi B, Hofstetter WL, Mehran RJ, Vaporciyan AA, Walsh GL, Swisher SG, Roth JA, Antonoff MB. Natural History of Ground-Glass Lesions Among Patients With Previous Lung Cancer. Ann Thorac Surg 2018; 105:1671-1677. [DOI: 10.1016/j.athoracsur.2018.01.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 12/17/2022]
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Lerner L, Winn R, Hulbert A. Lung cancer early detection and health disparities: the intersection of epigenetics and ethnicity. J Thorac Dis 2018; 10:2498-2507. [PMID: 29850158 DOI: 10.21037/jtd.2018.04.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Lung cancer is the most prominent cause of cancer-related mortality. Significant disparities in incidence and outcome characterize the disease's manifestations among ethnically and racially diverse populations. Complete surgical resection is the most effective curative treatment. However, success relies on early tumor detection. The National Lung Cancer Screening trial showed that lung cancer related mortality can be reduced by the use of low-dose CT (LDCT) screening. However, this test is plagued by a high false positive rate of 97% and the device itself is limited to designated cancer centers due to its expense and size. This restriction makes it difficult for underserved groups to access LDCT screening, the current standard of care. Highly sensitive and specific epigenetic DNA methylation-based biomarkers have the potential to work independently or in conjunction with LDCT screening to identify early-stage tumors. These tests could reduce unnecessary invasive confirmatory diagnostic tests and their associated morbidity and mortality. These tests also have the opportunity to bring lung cancer screening to the community thereby reducing unequal accessibility. However, epigenetic alterations are closely linked to the interplay between hereditary and environmental factors such as diet, lifestyle, ethnic ancestry, toxin exposure, residential segregation, and disparate community support structures. Despite this, the overwhelming number of early detection DNA methylation biomarker studies to date have either failed to control for ethnicity or have employed heavily Caucasian-biased patient cohorts. This review seeks to summarize the literature related to the early detection of lung cancer through molecular biomarkers among different ethnicities. Ethnical specific epigenetic biomarkers have the potential to be the first step towards an accessible, available personalized medicine approach to cancer through liquid biopsy.
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Affiliation(s)
- Lane Lerner
- 1University of Illinois at Chicago Cancer Center, 2Department of Surgery/Cancer Center University of Illinois at Chicago Cancer Center, University of Illinois Hospital and Health Sciences System, Chicago, USA
| | - Robert Winn
- 1University of Illinois at Chicago Cancer Center, 2Department of Surgery/Cancer Center University of Illinois at Chicago Cancer Center, University of Illinois Hospital and Health Sciences System, Chicago, USA
| | - Alicia Hulbert
- 1University of Illinois at Chicago Cancer Center, 2Department of Surgery/Cancer Center University of Illinois at Chicago Cancer Center, University of Illinois Hospital and Health Sciences System, Chicago, USA
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Houston KA, Mitchell KA, King J, White A, Ryan BM. Histologic Lung Cancer Incidence Rates and Trends Vary by Race/Ethnicity and Residential County. J Thorac Oncol 2018; 13:497-509. [PMID: 29360512 PMCID: PMC5884169 DOI: 10.1016/j.jtho.2017.12.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/30/2017] [Accepted: 12/21/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Lung cancer incidence is higher among non-Hispanic (NH) blacks than among the NH white and Hispanic populations in the United States. However, national cancer estimates may not always reflect the cancer burden in terms of disparities and incidence in small geographic areas, especially urban-rural disparities. Moreover, there is a gap in the literature regarding rural-urban disparities in terms of cancer histologic type. METHODS Using population-based cancer registry data-Surveillance, Epidemiology and End Results and National Program of Cancer Registries data-we present age-adjusted histologic rates and trends by race/ethnicity and residential county location at the time of first cancer diagnosis. Rate ratios were calculated to examine racial/ethnic differences in rates. Annual percent change was calculated to measure changes in rates over time. RESULTS We found that declines in squamous cell carcinoma are occurring fastest in metropolitan counties, whereas rates of adenocarcinoma increased fastest in counties nonadjacent to metropolitan areas. Further, although NH black men have increased lung cancer incidence compared with NH white and Hispanic men in all geographic locations, we found that the degree of the disparity increases with increasing rurality of residence. Finally, we discovered that among women whose lung cancer was diagnosed when they were younger than 55 years, the incidence of squamous cell carcinoma and adenocarcinoma was higher for NH blacks than for NH whites. CONCLUSIONS Our results highlight disparities among NH blacks in nonadjacent rural areas. These findings may have significant impact for the implementation of smoking cessation and lung cancer screening programs.
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Affiliation(s)
- Keisha A. Houston
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control
| | - Khadijah A. Mitchell
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892
| | - Jessica King
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control
| | - Arica White
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control
| | - Bríd M. Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892
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Patel MI, McKinley M, Cheng I, Haile R, Wakelee H, Gomez SL. Lung cancer incidence trends in California by race/ethnicity, histology, sex, and neighborhood socioeconomic status: An analysis spanning 28 years. Lung Cancer 2017. [PMID: 28625626 DOI: 10.1016/j.lungcan.2017.03.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Lung cancer incidence trends by histology, sex, race/ethnicity, and neighborhood socioeconomic status (nSES) have not been previously reported. We conducted a population-based study of lung cancer incidence over three peri-censal periods: 1988-1992, 1998-2002, and 2008-2012. MATERIALS AND METHODS We abstracted lung cancer cases from the California Cancer Registry and used US Census and American Community Survey data to develop multidimensional nSES indices for each census period. We calculated nSES tertile-specific incidence rates and rate ratios for each peri-censal period and used incidence rate ratios (IRR) to assess changes in rates from 1988 to 1992 to 1998-2002 and 2008-2012. RESULTS There were a total of 231,205 lung cancer cases. Males: Among males, incidence rates of lung cancer decreased over time, all race/ethnicities, and all nSES tertiles, with larger declines among males in higher nSES areas. Rates either declined or were stable for adenocarcinoma, with larger declines for other histologic subtypes. Females: Among females, declines in incidence rates of lung cancer were more pronounced for females in higher nSES areas, but diverged more so than for males, with variations by histology and race/ethnicity. Incidence rates of adenocarcinoma increased over time among all females, with greater increase among females in low nSES areas. CONCLUSIONS Our findings demonstrate differences in incidence trends over three decades by histology, gender, race/ethnicity, and nSES. While incidence rates consistently declined over time for males, there were greater declines in incidence for high nSES populations. In contrast, among females, there was evidence of increases in lung cancer incidence among low SES API females, and for adenocarcinoma.
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Affiliation(s)
- Manali I Patel
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA; Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Meg McKinley
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Fremont, CA, 94538, USA
| | - Iona Cheng
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Fremont, CA, 94538, USA
| | - Robert Haile
- Stanford Cancer Institute, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Heather Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA; Stanford Cancer Institute, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Fremont, CA, 94538, USA; Stanford Cancer Institute, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA
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Bollig-Fischer A. How the future of clinical cancer diagnostics can contribute to overcoming race-associated cancer disparities. Expert Rev Mol Diagn 2016; 16:1233-1235. [PMID: 27792413 DOI: 10.1080/14737159.2016.1254552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Haiman CA, Patel YM, Stram DO, Carmella SG, Chen M, Wilkens LR, Le Marchand L, Hecht SS. Benzene Uptake and Glutathione S-transferase T1 Status as Determinants of S-Phenylmercapturic Acid in Cigarette Smokers in the Multiethnic Cohort. PLoS One 2016; 11:e0150641. [PMID: 26959369 PMCID: PMC4784986 DOI: 10.1371/journal.pone.0150641] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/16/2016] [Indexed: 12/17/2022] Open
Abstract
Research from the Multiethnic Cohort (MEC) demonstrated that, for the same quantity of cigarette smoking, African Americans and Native Hawaiians have a higher lung cancer risk than Whites, while Latinos and Japanese Americans are less susceptible. We collected urine samples from 2,239 cigarette smokers from five different ethnic groups in the MEC and analyzed each sample for S-phenylmercapturic acid (SPMA), a specific biomarker of benzene uptake. African Americans had significantly higher (geometric mean [SE] 3.69 [0.2], p<0.005) SPMA/ml urine than Whites (2.67 [0.13]) while Japanese Americans had significantly lower levels than Whites (1.65 [0.07], p<0.005). SPMA levels in Native Hawaiians and Latinos were not significantly different from those of Whites. We also conducted a genome-wide association study in search of genetic risk factors related to benzene exposure. The glutathione S-transferase T1 (GSTT1) deletion explained between 14.2-31.6% (p = 5.4x10-157) and the GSTM1 deletion explained between 0.2%-2.4% of the variance (p = 1.1x10-9) of SPMA levels in these populations. Ethnic differences in levels of SPMA remained strong even after controlling for the effects of these two deletions. These results demonstrate the powerful effect of GSTT1 status on SPMA levels in urine and show that uptake of benzene in African American, White, and Japanese American cigarette smokers is consistent with their lung cancer risk in the MEC. While benzene is not generally considered a cause of lung cancer, its metabolite SPMA could be a biomarker for other volatile lung carcinogens in cigarette smoke.
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Affiliation(s)
- Christopher A. Haiman
- Department of Preventive Medicine and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, United States of America
| | - Yesha M. Patel
- Department of Preventive Medicine and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, United States of America
| | - Daniel O. Stram
- Department of Preventive Medicine and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90032, United States of America
| | - Steven G. Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55105, United States of America
| | - Menglan Chen
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55105, United States of America
| | - Lynne R. Wilkens
- Epidemiology Program, Cancer Research Center of Hawai’i, University of Hawai’i, Honolulu, HI, 96813, United States of America
| | - Loic Le Marchand
- Epidemiology Program, Cancer Research Center of Hawai’i, University of Hawai’i, Honolulu, HI, 96813, United States of America
| | - Stephen S. Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55105, United States of America
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Wang H, Park SL, Stram DO, Haiman CA, Wilkens LR, Hecht SS, Kolonel LN, Murphy SE, Le Marchand L. Associations Between Genetic Ancestries and Nicotine Metabolism Biomarkers in the Multiethnic Cohort Study. Am J Epidemiol 2015; 182:945-51. [PMID: 26568573 DOI: 10.1093/aje/kwv138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 05/19/2015] [Indexed: 01/18/2023] Open
Abstract
Differences in internal dose of nicotine and tobacco-derived carcinogens among ethnic/racial groups have been observed. In this study, we explicitly examined the relationships between genetic ancestries (genome-wide average) and 19 tobacco-derived biomarkers in smokers from 3 admixed groups in the Multiethnic Cohort Study (1993-present), namely, African ancestry in African Americans (n = 362), Amerindian ancestry in Latinos (n = 437), and Asian and Native Hawaiian ancestries in Native Hawaiians (n = 300). After multiple comparison adjustment, both African and Asian ancestries were significantly related to a greater level of free cotinine; African ancestry was also significantly related to lower cotinine glucuronidation (P's < 0.00156). The predicted decrease in cotinine glucuronidation was 8.6% (P = 4.5 × 10(-6)) per a 20% increase in African ancestry. Follow-up admixture mapping revealed that African ancestry in a 12-Mb region on chromosome 4q was related to lower cotinine glucuronidation (P's < 2.7 × 10(-7), smallest P = 1.5 × 10(-9)), although this is the same region reported in our previous genome-wide association study. Our results implicate a genetic ancestral component in the observed ethnic/racial variation in nicotine metabolism. Further studies are needed to identify the underlying genetic variation that could potentially be ethnic/racial specific.
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Abstract
INTRODUCTION Lung cancer is the leading cause of cancer-related deaths in the US. The reasons for higher incidence and poorer survival rates among black compared with white lung cancer patients have not been defined. We hypothesized that differential incidence of somatic cancer gene mutations may be a contributing factor. Previous genomic studies of non-small cell lung cancer (NSCLC) have not adequately represented black patients. METHODS A matrix-assisted laser desorption/ionization and time-of-flight mass spectrometry approach was used to analyze tumor DNA for 214 coding mutations in 26 cancer genes previously identified in NSCLC. The samples included NSCLC from 335 white patients and 137 black patients. For 299 of these, normal matched DNA was available and analyzed. RESULTS Epidermal growth factor receptor (EGFR) exon 19 deletions were only detected in women cases, with increased odds for black women compared with white women (odds ratio = 3.914, 95% confidence interval: 1.014-15.099, p = 0.048). Beyond race, variations in mutation frequencies were seen by histology. DDR2 alterations, previously described as somatic mutations, were identified as constitutional variants. CONCLUSIONS This study is among the largest comparing somatic mutations in black and white patients. The results point to the molecular diversity of NSCLC and raise new questions as to the importance of inherited alleles. Genomic tumor testing will benefit both populations, although the mutation spectrum appears to vary by sex, race, and histology.
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Brzezniak C, Satram-Hoang S, Goertz HP, Reyes C, Gunuganti A, Gallagher C, Carter CA. Survival and Racial Differences of Non-Small Cell Lung Cancer in the United States Military. J Gen Intern Med 2015; 30:1406-12. [PMID: 25805503 PMCID: PMC4579211 DOI: 10.1007/s11606-015-3280-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 02/04/2015] [Accepted: 03/02/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death in the United States (US) Military and worldwide, with non-small cell lung cancer (NSCLC) accounting for 87 % of cases. OBJECTIVES Using a US military cohort who receives equal and open access to healthcare, we sought to examine demographic, clinical features and outcomes with NSCLC. DESIGN AND PARTICIPANTS We conducted a retrospective cohort analysis of 4,751 patients, aged ≥ 18 years and diagnosed with a first primary NSCLC between 1 January 2003 and 31 December 2013 in the US Department of Defense (DoD) cancer registry. MAIN MEASURES Differences by patient and disease characteristics were compared using Chi-square and t-test. Kaplan Meier curves and Cox proportional hazards regression assessed overall survival. RESULTS The mean age at diagnosis was 66 years, 64 % were male, 72 % were Caucasian, 41 % were diagnosed at early stage, 77 % received treatment and 82 % had a history of tobacco use. Mean age at diagnosis was highest among Caucasians (67 years) and lowest among African Americans (AA; 62 years). Asian/Pacific Islanders (PI) were more likely to be female (p < 0.0001), have adenocarcinoma histology (p = 0.0003) and less likely to have a history of tobacco use (p < 0.0001) compared to other racial/ethnic groups. In multivariable survival analysis, older age, male gender, increasing stage, not receiving treatment, and tobacco history were associated with higher mortality risk. Untreated patients exhibited a 39 % higher mortality risk compared to treated patients (HR = 1.39; 95%CI = 1.23-1.57). Compared to Caucasian patients, Asian/PIs demonstrated a 20 % lower risk of death (HR = 0.80; 95%CI = 0.66-0.96). There was no difference in mortality risk between AAs and Hispanics compared to Caucasians. CONCLUSION The lack of significant outcome disparity between AAs and Caucasians and the earlier stage at diagnosis than usually seen in civilian populations suggest that equal access to healthcare may play a role in early detection and survival.
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Affiliation(s)
- Christina Brzezniak
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889-5600, USA
| | - Sacha Satram-Hoang
- Q.D. Research, Inc, 8777 Auburn Folsom Road Suite C501, Granite Bay, 95746, CA, USA
| | | | - Carolina Reyes
- Genentech, Inc, 1 DNA Way, South San Francisco, 94080, CA, USA
| | - Ashok Gunuganti
- Q.D. Research, Inc, 8777 Auburn Folsom Road Suite C501, Granite Bay, 95746, CA, USA
| | - Christopher Gallagher
- Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving St NW C2149, Washington, 20010, DC, USA
| | - Corey A Carter
- John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889-5600, USA.
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Park SL, Carmella SG, Chen M, Patel Y, Stram DO, Haiman CA, Le Marchand L, Hecht SS. Mercapturic Acids Derived from the Toxicants Acrolein and Crotonaldehyde in the Urine of Cigarette Smokers from Five Ethnic Groups with Differing Risks for Lung Cancer. PLoS One 2015; 10:e0124841. [PMID: 26053186 PMCID: PMC4460074 DOI: 10.1371/journal.pone.0124841] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/17/2015] [Indexed: 12/27/2022] Open
Abstract
The Multiethnic Cohort epidemiology study has clearly demonstrated that, compared to Whites and for the same number of cigarettes smoked, African Americans and Native Hawaiians have a higher risk for lung cancer whereas Latinos and Japanese Americans have a lower risk. Acrolein and crotonaldehyde are two important constituents of cigarette smoke which have well documented toxic effects and could play a role in lung cancer etiology. Their urinary metabolites 3-hydroxypropylmercapturic acid (3-HPMA) and 3-hydroxy-1-methylpropylmercapturic acid (HMPMA), respectively, are validated biomarkers of acrolein and crotonaldehyde exposure. We quantified levels of 3-HPMA and HMPMA in the urine of more than 2200 smokers from these five ethnic groups, and also carried out a genome wide association study using blood samples from these subjects. After adjusting for age, sex, creatinine, and total nicotine equivalents, geometric mean levels of 3-HPMA and HMPMA were significantly different in the five groups (P < 0.0001). Native Hawaiians had the highest and Latinos the lowest geometric mean levels of both 3-HPMA and HMPMA. Levels of 3-HPMA and HMPMA were 3787 and 2759 pmol/ml urine, respectively, in Native Hawaiians and 1720 and 2210 pmol/ml urine in Latinos. These results suggest that acrolein and crotonaldehyde may be involved in lung cancer etiology, and that their divergent levels may partially explain the differing risks of Native Hawaiian and Latino smokers. No strong signals were associated with 3-HPMA in the genome wide association study, suggesting that formation of the glutathione conjugate of acrolein is mainly non-enzymatic, while the top significant association with HMPMA was located on chromosome 12 near the TBX3 gene, but its relationship to HMPMA excretion is not clear.
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Affiliation(s)
- Sungshim L. Park
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Steven G. Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Menglan Chen
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Yesha Patel
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Daniel O. Stram
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Christopher A. Haiman
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Loic Le Marchand
- University of Hawaii Cancer Center, Honolulu, Hawaii, United States of America
| | - Stephen S. Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, United States of America
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Akushevich I, Arbeev K, Kravchenko J, Berry M. Causal effects of time-dependent treatments in older patients with non-small cell lung cancer. PLoS One 2015; 10:e0121406. [PMID: 25849715 PMCID: PMC4388569 DOI: 10.1371/journal.pone.0121406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 02/01/2015] [Indexed: 11/18/2022] Open
Abstract
Background Treatment selection for elderly patients with lung cancer must balance the benefits of curative/life-prolonging therapy and the risks of increased mortality due to comorbidities. Lung cancer trials generally exclude patients with comorbidities and current treatment guidelines do not specifically consider comorbidities, so treatment decisions are usually made on subjective individual-case basis. Methods Impacts of surgery, radiation, and chemotherapy mono-treatment as well as combined chemo/radiation on one-year overall survival (compared to no-treatment) are studied for stage-specific lung cancer in 65+ y.o. patients. Methods of causal inference such as propensity score with inverse probability weighting (IPW) for time-independent and marginal structural model (MSM) for time-dependent treatments are applied to SEER-Medicare data considering the presence of comorbid diseases. Results 122,822 patients with stage I (26.8%), II (4.5%), IIIa (11.5%), IIIb (19.9%), and IV (37.4%) lung cancer were selected. Younger age, smaller tumor size, and fewer baseline comorbidities predict better survival. Impacts of radio- and chemotherapy increased and impact of surgery decreased with more advanced cancer stages. The effects of all therapies became weaker after adjustment for selection bias, however, the changes in the effects were minor likely due to the weak selection bias or incompleteness of the list of predictors that impacted treatment choice. MSM provides more realistic estimates of treatment effects than the IPW approach for time-independent treatment. Conclusions Causal inference methods provide substantive results on treatment choice and survival of older lung cancer patients with realistic expectations of potential benefits of specific treatments. Applications of these models to specific subsets of patients can aid in the development of practical guidelines that help optimize lung cancer treatment based on individual patient characteristics.
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Affiliation(s)
- Igor Akushevich
- Center for Population Health and Aging, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Konstantin Arbeev
- Center for Population Health and Aging, Duke University, Durham, North Carolina, United States of America
| | - Julia Kravchenko
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Mark Berry
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California, United States of America
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Park SL, Carmella SG, Ming X, Vielguth E, Stram DO, Le Marchand L, Hecht SS. Variation in levels of the lung carcinogen NNAL and its glucuronides in the urine of cigarette smokers from five ethnic groups with differing risks for lung cancer. Cancer Epidemiol Biomarkers Prev 2015; 24:561-9. [PMID: 25542827 PMCID: PMC4355389 DOI: 10.1158/1055-9965.epi-14-1054] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Results of the Multiethnic Cohort (MEC) study demonstrated that, for the same quantity of cigarettes smoked, African Americans and Native Hawaiians have a higher risk of lung cancer compared with whites, whereas Latinos and Japanese Americans have a lower risk. We hypothesize that the uptake and/or metabolism of the lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) could explain the differences in lung cancer risk. METHODS We measured urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and its glucuronides and their sum (total NNAL), biomarkers of NNK uptake, in 2,252 smokers from the MEC. Ethnic-specific geometric means were compared adjusting for age at urine collection, sex, creatinine and total nicotine equivalents, a marker of total nicotine uptake. RESULTS African Americans had the highest median total NNAL levels (1.80 pmol/mL urine) and Japanese Americans had the lowest (0.914 pmol/mL urine), with intermediate values in the other three groups. Geometric mean of total NNAL in African Americans was also highest, and in Japanese Americans it was lowest; Japanese American geometric mean was statistically different from whites (P = 0.004). CONCLUSIONS African Americans had higher levels of total NNAL per mL urine than whites, while Japanese Americans had lower levels, consistent with lung cancer risk among smokers in these groups. However, our data were not consistent with the high and low lung cancer risks of Native Hawaiian and Latino smokers, respectively. IMPACT The higher lung cancer susceptibility of African-American smokers and the lower susceptibility of Japanese-American smokers compared with whites can be explained in part by exposure to the potent lung carcinogen NNK. Cancer Epidemiol Biomarkers Prev; 24(3); 561-9. ©2014 AACR.
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Affiliation(s)
- Sungshim L Park
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Steven G Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Xun Ming
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | | | - Daniel O Stram
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
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Phelps MA, Stinchcombe TE, Blachly JS, Zhao W, Schaaf LJ, Starrett SL, Wei L, Poi M, Wang D, Papp A, Aimiuwu J, Gao Y, Li J, Otterson GA, Hicks WJ, Socinski MA, Villalona-Calero MA. Erlotinib in African Americans with advanced non-small cell lung cancer: a prospective randomized study with genetic and pharmacokinetic analyses. Clin Pharmacol Ther 2014; 96:182-91. [PMID: 24781527 DOI: 10.1038/clpt.2014.93] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 04/15/2014] [Indexed: 11/09/2022]
Abstract
Prospective studies on epidermal growth factor receptor (EGFR) inhibitors in African Americans with non-small cell lung cancer (NSCLC) have not previously been performed. In this phase II randomized study, 55 African Americans with NSCLC received 150 mg/day erlotinib or a body weight-adjusted dose with subsequent escalations to the maximum-allowable dose, 200 mg/day, to achieve rash. Erlotinib and OSI-420 exposures were lower than those observed in previous studies, consistent with CYP3A pharmacogenetics implying higher metabolic activity. Tumor genetics showed only two EGFR mutations, EGFR amplification in 17/47 samples, eight KRAS mutations, and five EML4-ALK translocations. Although absence of rash was associated with shorter time to progression (TTP), disease-control rate, TTP, and 1-year survival were not different between the two dose groups, indicating the dose-to-rash strategy failed to increase clinical benefit. Low incidence of toxicity and low erlotinib exposure suggest standardized and maximum-allowable dosing may be suboptimal in African Americans.
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Affiliation(s)
- M A Phelps
- 1] College of Pharmacy, The Ohio State University, Columbus, Ohio, USA [2] College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - T E Stinchcombe
- University of North Carolina College of Medicine, Chapel Hill, North Carolina, USA
| | - J S Blachly
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - W Zhao
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - L J Schaaf
- 1] College of Pharmacy, The Ohio State University, Columbus, Ohio, USA [2] College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - S L Starrett
- Wexner Medical Center, Department of Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - L Wei
- Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - M Poi
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - D Wang
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - A Papp
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - J Aimiuwu
- College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Y Gao
- College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - J Li
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - G A Otterson
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - W J Hicks
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - M A Socinski
- University of North Carolina College of Medicine, Chapel Hill, North Carolina, USA
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Race and ethnicity in cancer therapy: what have we learned? Clin Pharmacol Ther 2014; 95:403-12. [PMID: 24419564 DOI: 10.1038/clpt.2014.5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 01/06/2014] [Indexed: 12/13/2022]
Abstract
Racial and ethnic disparities in the pathogenesis of common malignancies and outcomes from treatment remain a major health concern. Factors attributed to these disparities include differences in lifestyle, environment, genetics, and tumor biology. As we strive to personalize cancer therapy, it will be imperative that we understand the relative contributions of each factor so that we may apply this knowledge in choosing the best treatment for each individual, regardless of his or her racial or ethnic heritage.
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Variability in the treatment of elderly patients with stage IIIA (N2) non-small-cell lung cancer. J Thorac Oncol 2014; 8:744-52. [PMID: 23571473 DOI: 10.1097/jto.0b013e31828916aa] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION : We evaluated treatment patterns of elderly patients with stage IIIA (N2) non-small-cell lung cancer (NSCLC). METHODS : The use of surgery, chemotherapy, and radiation for patients with stage IIIA (T1-T3N2M0) NSCLC in the Surveillance, Epidemiology, and End Results-Medicare database from 2004 to 2007 was analyzed. Treatment variability was assessed using a multivariable logistic regression model that included treatment, patient, tumor, and census track variables. Overall survival was analyzed using the Kaplan-Meier approach and Cox proportional hazard models. RESULTS : The most common treatments for 2958 patients with stage IIIA (N2) NSCLC were radiation with chemotherapy (n = 1065, 36%), no treatment (n = 534, 18%), and radiation alone (n = 383, 13%). Surgery was performed in 709 patients (24%): 235 patients (8%) had surgery alone, 40 patients (1%) had surgery with radiation, 222 patients had surgery with chemotherapy (8%), and 212 patients (7%) had surgery, chemotherapy, and radiation. Younger age (p < 0.0001), lower T-status (p < 0.0001), female sex (p = 0.04), and living in a census track with a higher median income (p = 0.03) predicted surgery use. Older age (p < 0.0001) was the only factor that predicted that patients did not get any therapy. The 3-year overall survival was 21.8 ± 1.5% for all patients, 42.1 ± 3.8% for patients that had surgery, and 15.4 ± 1.5% for patients that did not have surgery. Increasing age, higher T-stage and Charlson Comorbidity Index, and not having surgery, radiation, or chemotherapy were all risk factors for worse survival (all p values < 0.001). CONCLUSIONS : Treatment of elderly patients with stage IIIA (N2) NSCLC is highly variable and varies not only with specific patient and tumor characteristics but also with regional income level.
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Prospective Observational Comparison of Clinical Outcomes Between African-American and Caucasian Patients Receiving Second-Line Treatment With Pemetrexed for Advanced Non–Small-Cell Lung Cancer. Clin Lung Cancer 2013; 14:726-35. [DOI: 10.1016/j.cllc.2013.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 06/24/2013] [Accepted: 06/25/2013] [Indexed: 11/18/2022]
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Göcze I, Strenge F, Zeman F, Creutzenberg M, Graf BM, Schlitt HJ, Bein T. The effects of the semirecumbent position on hemodynamic status in patients on invasive mechanical ventilation: prospective randomized multivariable analysis. Crit Care 2013; 17:R80. [PMID: 23622019 PMCID: PMC4056784 DOI: 10.1186/cc12694] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 02/07/2013] [Accepted: 04/26/2013] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Adopting the 45° semirecumbent position in mechanically ventilated critically ill patients is recommended, as it has been shown to reduce the incidence of ventilator-associated pneumonia. Although the benefits to the respiratory system are clear, it is not known whether elevating the head of the bed results in hemodynamic instability. We examined the effect of head of bed elevation (HBE) on hemodynamic status and investigated the factors that influence mean arterial pressure (MAP) and central venous oxygen saturation (ScvO2) when patients were positioned at 0°, 30°, and 45°. METHODS Two hundred hemodynamically stable adults on invasive mechanical ventilation admitted to a multidisciplinary surgical intensive care unit were recruited. Patients' characteristics included catecholamine and sedative doses, the original angle of head of bed elevation (HBE), the level of positive end expiratory pressure (PEEP), duration and mode of mechanical ventilation. A sequence of HBE positions (0°, 30°, and 45°) was adopted in random order, and MAP and ScvO2 were measured at each position. Patients acted as their own controls. The influence of degree of HBE and of the covariables on MAP and ScvO2 was analyzed by using liner mixed models. Additionally, uni- and multivariable logistic regression models were used to indentify risk factors for hypotension during HBE, defined as MAP <65 mmHg. RESULTS Changing HBE from supine to 45° caused significant reductions in MAP (from 83.8 mmHg to 71.1 mmHg, P < 0.001) and ScvO2 (76.1% to 74.3%, P < 0.001). Multivariable modeling revealed that mode and duration of mechanical ventilation, the norepinephrine dose, and HBE had statistically significant influences. Pressure-controlled ventilation was the most influential risk factor for hypotension when HBE was 45° (odds ratio (OR) 2.33, 95% confidence interval (CI), 1.23 to 4.76, P = 0.017). CONCLUSIONS HBE to the 45° position is associated with significant decreases in MAP and ScvO2 in mechanically ventilated patients. Pressure-controlled ventilation, higher simplified acute physiology (SAPS II) score, sedation, high catecholamine, and PEEP requirements were identified as independent risk factors for hypotension after backrest elevation. Patients at risk may need positioning at 20° to 30° to overcome the negative effects of HBE, especially in the early phase of intensive care unit admission.
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Affiliation(s)
- Ivan Göcze
- Department of Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
| | - Felix Strenge
- University of Regensburg, Universitätstrasse 31, D-93053 Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
| | - Marcus Creutzenberg
- Department of Anaesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
| | - Bernhard M Graf
- Department of Anaesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
| | - Hans J Schlitt
- Department of Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
| | - Thomas Bein
- Department of Anaesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
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Wille KM, Harrington KF, deAndrade JA, Vishin S, Oster RA, Kaslow RA. Disparities in lung transplantation before and after introduction of the lung allocation score. J Heart Lung Transplant 2013; 32:684-92. [PMID: 23582477 DOI: 10.1016/j.healun.2013.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 02/27/2013] [Accepted: 03/06/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In May 2005, the Lung Allocation Score (LAS) became the primary method for determining allocation of lungs for organ transplantation for those at least 12 years of age in the United States. During the pre-LAS period, black patients were more likely than white patients to become too sick or die while awaiting transplant. The association between gender and lung transplant outcomes has not been widely studied. METHODS Black and white patients aged ≥ 18 years registered on the United Network for Organ Sharing (UNOS) lung transplantation waiting list from January 1, 2000, to May 3, 2005 (pre-LAS, n = 8,765), and from May 4, 2005, to September 4, 2010 (LAS, n = 8,806), were included. Logistic regression analyses were based on smaller cohorts derived from patients listed in the first 2 years of each era (2,350 pre-LAS, and 2,446 LAS) to allow for follow-up time. Lung transplantation was the primary outcome measure. Multivariable analyses were performed within each interval to determine the odds that a patient would die or receive a lung transplant within 3 years of listing. RESULTS In the pre-LAS era, black patients were more likely than white patients to become too sick for transplantation or die within 3 years of waiting list registration (43.8% vs 30.8%; odds ratio [OR], 1.84; p < 0.001). Race was not associated with death or becoming too sick while listed for transplantation in the LAS era (14.0% vs 13.3%; OR, 0.93; p = 0.74). Black patients were less likely to undergo transplantation in the pre-LAS era (56.3% vs 69.2%; OR, 0.54; p < 0.001) but not in the LAS era (86.0% vs 86.7%; OR, 1.07; p = 0.74). Women were more likely than men to die or become too sick for transplantation within 3 years of listing in the LAS era (16.1% vs 11.3%; OR, 1.58; p < 0.001) compared with the pre-LAS era (33.4% vs 30.7%; OR, 1.19; p = 0.08). CONCLUSION Racial disparities in lung transplantation have decreased with the implementation of LAS as the method of organ allocation; however, gender disparities may have actually increased in the LAS era.
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Affiliation(s)
- Keith M Wille
- Departments of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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El-Telbany A, Ma PC. Cancer genes in lung cancer: racial disparities: are there any? Genes Cancer 2012; 3:467-80. [PMID: 23264847 DOI: 10.1177/1947601912465177] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 09/18/2012] [Indexed: 12/11/2022] Open
Abstract
Cancer is now known as a disease of genomic alterations. Mutational analysis and genomics profiling in recent years have advanced the field of lung cancer genetics/genomics significantly. It is becoming more accepted now that the identification of genomic alterations in lung cancer can impact therapeutics, especially when the alterations represent "oncogenic drivers" in the processes of tumorigenesis and progression. In this review, we will highlight the key driver oncogenic gene mutations and fusions identified in lung cancer. The review will summarize and report the available demographic and clinicopathological data as well as molecular details behind various lung cancer gene alterations in the context of race. We hope to shed some light into the disparities in the incidence of various genetic mutations among lung cancer patients of different racial backgrounds. As molecularly targeted therapy continues to advance in lung cancer, racial differences in specific genetic/genomic alterations can have an important impact in the choices of therapeutics and in our understanding of the drug sensitivity/resistance profile. The most relevant genes in lung cancer described in this review include the following: EGFR, KRAS, MET, LKB1, BRAF, PIK3CA, ALK, RET, and ROS1. Commonly identified genetic/genomic alterations such as missense or nonsense mutations, small insertions or deletions, alternative splicing, and chromosomal fusion rearrangements were discussed. Relevance in current targeted therapeutic drugs was mentioned when appropriate. We also highlighted various targeted therapeutics that are currently under clinical development, such as the MET inhibitors and antibodies. With the advent of next-generation sequencing, the landscape of genomic alterations in lung cancer is expected to be much transformed and detailed in upcoming years. These genomic landscape differences in the context of racial disparities should be emphasized both in tumorigenesis and in drug sensitivity/resistance. It is hoped that such effort will help to diminish racial disparities in lung cancer outcome in the future.
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Affiliation(s)
- Ahmed El-Telbany
- Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA ; Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Walsh KM, Gorlov IP, Hansen HM, Wu X, Spitz MR, Zhang H, Lu EY, Wenzlaff AS, Sison JD, Wei C, Lloyd SM, Chen W, Frazier ML, Seldin MF, Bierut LJ, Bracci PM, Wrensch MR, Schwartz AG, Wiencke JK, Amos CI. Fine-mapping of the 5p15.33, 6p22.1-p21.31, and 15q25.1 regions identifies functional and histology-specific lung cancer susceptibility loci in African-Americans. Cancer Epidemiol Biomarkers Prev 2012; 22:251-60. [PMID: 23221128 DOI: 10.1158/1055-9965.epi-12-1007-t] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Genome-wide association studies of European and East Asian populations have identified lung cancer susceptibility loci on chromosomes 5p15.33, 6p22.1-p21.31, and 15q25.1. We investigated whether these regions contain lung cancer susceptibly loci in African-Americans and refined previous association signals by using the reduced linkage disequilibrium observed in African-Americans. METHODS 1,308 African-American cases and 1,241 African-American controls from 3 centers were genotyped for 760 single-nucleotide polymorphisms (SNP) spanning 3 regions, and additional SNP imputation was carried out. Associations between polymorphisms and lung cancer risk were estimated using logistic regression, stratified by tumor histology where appropriate. RESULTS The strongest associations were observed on 15q25.1 in/near CHRNA5, including a missense substitution [rs16969968: OR, 1.57; 95% confidence interval (CI), 1.25-1.97; P, 1.1 × 10(-4)) and variants in the 5'-UTR. Associations on 6p22.1-p21.31 were histology specific and included a missense variant in BAT2 associated with squamous cell carcinoma (rs2736158: OR, 0.64; 95% CI, 0.48-0.85; P, 1.82 × 10(-3)). Associations on 5p15.33 were detected near TERT, the strongest of which was rs2735940 (OR, 0.82; 95% CI, 0.73-0.93; P, 1.1 × 10(-3)). This association was stronger among cases with adenocarcinoma (OR, 0.75; 95% CI, 0.65-0.86; P, 8.1 × 10(-5)). CONCLUSIONS Polymorphisms in 5p15.33, 6p22.1-p21.31, and 15q25.1 are associated with lung cancer in African-Americans. Variants on 5p15.33 are stronger risk factors for adenocarcinoma and variants on 6p21.33 associated only with squamous cell carcinoma. IMPACT Results implicate the BAT2, TERT, and CHRNA5 genes in the pathogenesis of specific lung cancer histologies.
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Affiliation(s)
- Kyle M Walsh
- Program in Cancer Genetics, Helen Diller Family Comprehensive Cancer Cente, San Francisco, CA, USA.
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Jonnalagadda S, Lin JJ, Nelson JE, Powell CA, Salazar-Schicchi J, Berman AR, Keller SM, Smith CB, Lurslurchachai L, Halm EA, Leventhal H, Wisnivesky JP. Racial and ethnic differences in beliefs about lung cancer care. Chest 2012; 142:1251-1258. [PMID: 22700777 PMCID: PMC3494476 DOI: 10.1378/chest.12-0330] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/05/2012] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Disparities in lung cancer treatment and palliative care are well documented. However,the mechanisms underlying these disparities are not fully understood. In this study, we evaluated racial and ethnic differences in beliefs and attitudes about lung cancer treatment and palliative care among patients receiving a new diagnosis of lung cancer. METHODS Patients were recruited from four medical centers in New York City and surveyed about their beliefs regarding lung cancer care, including disease-directed treatments, palliative and end-of-life care, and fatalistic and spiritual beliefs. We used univariate and multiple regression analyses to compare the distribution of beliefs among minority (black and Hispanic) and nonminority patients. RESULTS Of the 335 patients, 21% were black, 20% were Hispanic, and 59% were nonminority. Beliefs about chemotherapy and radiotherapy were similar across the three groups ( P > .05),whereas black patients were more likely to believe that surgery might cause lung cancer to spread( P =.008). Fatalistic beliefs potentially affecting cancer treatment were more common among both minority groups ( P ≤ .02). No signifi cant differences were found in attitudes toward clinician communication about cancer prognosis ( P > .05). However, both blacks and Hispanics were more likely to have misconceptions about advance directives and hospice care ( P ≤ .02). CONCLUSIONS Similarities and differences in beliefs about disease-directed treatment were observed between minority and nonminority patients with lung cancer. Minority patients hold more fatalistic views about the disease and misperceptions about advance care planning and hospice care. Further research is needed to assess the impact of these beliefs on decisions about lung cancer care and patient outcomes.
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Affiliation(s)
- Sirisha Jonnalagadda
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, NJ
| | - Jenny J Lin
- Division of General Internal Medicine, New York, NY
| | - Judith E Nelson
- Division of Pulmonary, Critical Care and Sleep Medicine, New York, NY; Hertzberg Palliative Care Institute, Brookdale Department of Geriatrics and Palliative Medicine, The Mount Sinai Hospital, New York, NY
| | - Charles A Powell
- Division of Pulmonary, Critical Care and Sleep Medicine, New York, NY
| | | | - Andrew R Berman
- Division of Pulmonary and Critical Care Medicine, University of Medicine and Dentistry of New Jersey, Newark, NJ
| | - Steven M Keller
- Department of Thoracic Surgery, Albert Einstein College of Medicine, Bronx, NY
| | - Cardinale B Smith
- Division of Hematology and Oncology, Mount Sinai School of Medicine, New York, NY; Hertzberg Palliative Care Institute, Brookdale Department of Geriatrics and Palliative Medicine, The Mount Sinai Hospital, New York, NY
| | | | - Ethan A Halm
- Department of Medicine, University of Texas Southwestern, Dallas, TX
| | | | - Juan P Wisnivesky
- Division of General Internal Medicine, New York, NY; Division of Pulmonary, Critical Care and Sleep Medicine, New York, NY.
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Holgersson G, Hoye E, Bergqvist M, Ekman S, Nyman J, Helsing M, Friesland S, Holgersson M, Ekberg L, Blystad T, Ewers SB, Mörth C, Löden B, Henriksson R, Bergström S. Swedish Lung Cancer Radiation Study Group: predictive value of age at diagnosis for radiotherapy response in patients with non-small cell lung cancer. Acta Oncol 2012; 51:759-67. [PMID: 22793039 DOI: 10.3109/0284186x.2012.681064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The aim of the present study was to investigate the impact of age at diagnosis on prognosis in patients treated with curatively intended radiotherapy for NSCLC. MATERIAL AND METHODS This is a joint effort among all the Swedish Oncology Departments that includes all identified patients with a diagnosed non-small cell lung cancer that have been subjected to curatively intended irradiation (≥50 Gy) treated during 1990 to 2000. Included patients had a histopathological/cytological diagnosis date as well as a death date or a last follow-up date. The following variables were studied in relation to overall and disease-specific survival: age, gender, histopathology, time period, smoking status, stage and treatment. RESULTS The median overall survival of all 1146 included patients was 14.7 months, while the five-year overall survival rate was 9.5%. Younger patients (<55 years), presented with a more advanced clinical stage but had yet a significantly better overall survival compared with patients in the age groups 55-64 years (p = 0.035) and 65-74 years (p = 0.0097) in a multivariate Cox regression analysis. The overall survival of patients aged ≥75 years was comparable to those aged <55 years. CONCLUSION In this large retrospective study we describe that patients younger than 55 years treated with curatively intended radiotherapy for NSCLC have a better overall survival than patients aged 55-64 and 65-74 years and that younger patients seem to benefit more from the addition of surgery and/or chemotherapy to radiotherapy. Due to the exploratory nature of the study, these results should be confirmed in future prospective trials.
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Blakely T, Soeberg M, Carter K, Costilla R, Atkinson J, Sarfati D. Bias in relative survival methods when using incorrect life-tables: Lung and bladder cancer by smoking status and ethnicity in New Zealand. Int J Cancer 2012; 131:E974-82. [DOI: 10.1002/ijc.27531] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 02/23/2012] [Indexed: 11/11/2022]
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Park ER, Kleimann S, Youatt EJ, Lockhart A, Campbell EG, Levy DE, Halbert CH, Schmieder E, Krishna R, Shields AE. Black and White adults' perspectives on the genetics of nicotine addiction susceptibility. Addict Behav 2011; 36:769-72. [PMID: 21406316 DOI: 10.1016/j.addbeh.2011.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/18/2011] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Abstract
AIMS Emerging research may soon lead to improved quit rates via genetically-tailored smoking cessation treatment. The purpose of this study was to explore individuals' beliefs and attitudes about genetic testing in this context, and how these may differ across racial groups. DESIGN Two site qualitative study. METHODS Eleven focus groups were conducted in 2007 with 51 Black and 55 White adult participants in Montgomery, AL and Baltimore, MD. MEASUREMENTS Questions were asked about smoking as an addiction, the role of genetics in nicotine addiction susceptibility, and undergoing genetic testing to receive tailored smoking cessation treatment. Data were analyzed using content analysis. FINDINGS Most participants believed that smoking was an addiction yet were unwilling to endorse the notion that genetics played a role in nicotine addiction susceptibility. However, 91% of White participants and 62% of Black participants indicated that they would likely take a genetic test that would match them to their optimal smoking cessation treatment. The primary potential benefit was a vague sense that additional knowledge about oneself would be of value. Primary barriers included disinterest and skepticism about the test, unwillingness to believe that genetics played a role in nicotine addiction or treatment response, and concerns about psychological consequences. CONCLUSIONS The majority of participants, particularly Black participants, did not believe that genetics played a significant role in nicotine addiction susceptibility but were willing to undergo genetic testing. Participants identified some benefit to tailoring smoking treatment by genotype. However, participants also expressed skepticism about the test and concerns about its consequences; these issues would need to be addressed in the clinical encounter.
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Cetin K, Ettinger DS, Hei YJ, O'Malley CD. Survival by histologic subtype in stage IV nonsmall cell lung cancer based on data from the Surveillance, Epidemiology and End Results Program. Clin Epidemiol 2011; 3:139-48. [PMID: 21607015 PMCID: PMC3096514 DOI: 10.2147/clep.s17191] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Indexed: 12/12/2022] Open
Abstract
Background: The role of histology in the targeted management of nonsmall cell lung cancer (NSCLC) has garnered renewed attention in recent years. We provide contemporary population-based estimates of survival and an assessment of important prognostic factors in stage IV NSCLC by major histologic subtype. Methods: Using data from the Surveillance, Epidemiology and End Results (SEER) Program, we stratified 51,749 incident stage IV NSCLC patients (1988–2003 with follow-up through 2006) by major histologic subtype. We used Kaplan–Meier and Cox proportional hazards methods to describe overall survival and the prognostic influence of select patient, tumor, and treatment characteristics for each histologic subgroup. Results: Survival was highest in patients with bronchioloalveolar adenocarcinoma (1-year survival: 29.1%) and lowest in those with large cell tumors (1-year survival: 12.8%). Diagnosis in later years, female gender, younger age, either Asian/Pacific Islander or Hispanic race/ethnicity, lower tumor grade, and surgery or beam radiation as part of first-line treatment were generally independently associated with a decreased risk of death, but the prognostic significance of some of these factors (age, ethnicity, tumor grade) varied according to histologic subtype. Conclusion: Findings demonstrate a poor prognosis across histologic subtypes in stage IV NSCLC patients but highlight differences in both absolute survival and the relative importance of select prognostic factors by histologic subclassification. More research using other sources of population-based data could help clarify the role of histology in the presentation, management, and prognosis of late-stage NSCLC.
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Affiliation(s)
- Karynsa Cetin
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
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A Comparison of white and African American outcomes from a three-arm, randomized, phase III multicenter trial of advanced or metastatic non-small cell lung cancer. J Thorac Oncol 2010; 5:993-1000. [PMID: 20593535 DOI: 10.1097/jto.0b013e3181e29cf3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the effect of race on the efficacy and safety of standard chemotherapy doublet regimens in African American patients, we conducted a subgroup analysis of a phase III randomized trial. PATIENTS AND METHODS Chemonaïve patients with a performance status of 0 or 1 and stage IIIB or IV non-small cell lung cancer were randomized to arm A: gemcitabine 1000 mg/m2 on days 1 and 8 plus carboplatin area under the curve 5.5 on day 1; arm B: the same schedule of gemcitabine plus paclitaxel 200 mg/m2 on day 1; or arm C: paclitaxel 225 mg/m2 on day 1 plus carboplatin area under the curve 6.0 on day 1. Cycles were repeated every 21 days up to 6. A site selection tool identified institutions with potential to recruit a minority population. Outcome and toxicity data of white and African American patients were compared. RESULTS Of 1135 total patients, 972 were white (85.6%) and 138 were African American (12.2%). Median survival was 8.3 months for white patients (95% confidence interval [CI]: 7.7-9.3) and 9.1 months for African American patients (95% CI: 8.2-11.1). Response rates were 29.1 and 29.0%, respectively. Rates of grade 3 or 4 toxicities were comparable. Among African Americans, median survival was 7.2 months (95% CI: 5.1-10.1) for gemcitabine-carboplatin (n = 47), 10.5 months (95% CI: 7.1-15.4) for gemcitabine-paclitaxel (n = 42), and 10.2 months (95% CI: 8.5-13.2) for paclitaxel-carboplatin (n = 49). CONCLUSION Whites and African Americans had similar outcomes, although there was some variability in survival among African Americans across the three treatment groups.
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Said R, Terjanian T, Taioli E. Clinical characteristics and presentation of lung cancer according to race and place of birth. Future Oncol 2010; 6:1353-61. [DOI: 10.2217/fon.10.89] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This study compares the clinical presentation and characteristics of lung cancer among white and black patients according to place of birth, and correlates these factors to outcome. All newly diagnosed lung cancers from 2005 to 2007 in three tertiary medical centers were retrospectively reviewed; 767 patients were identified, 252 of whom were black. Age, sex, family history, place of birth, smoking history, insurance status, clinical stage, histology, grade of differentiation, symptoms, circumstance of diagnosis, treatment and outcome data were retrieved from medical charts. Lung cancer was diagnosed incidentally in 28.2% of white individuals versus 12.3% in black individuals (p < 0.0001). After adjustment for other variables, black and white individuals have similar survival rates (hazard ratio: 1.3; 95% CI: 0.8–2.0). The differences in lung cancer survival could be related to access to care, environmental factors and the biology of the disease. Including place of birth in cancer outcome studies could help understanding the origin of health disparity.
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Affiliation(s)
- Rabih Said
- State University of New York, Downstate Medical Center, NY, USA
- Staten Island University Hospital, Department of Hematology/Oncology, Staten Island, NY, USA
| | - Terenig Terjanian
- Staten Island University Hospital, Department of Hematology/Oncology, Staten Island, NY, USA
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Racial and Ethnic Diversity in Lung Cancer. Lung Cancer 2010. [DOI: 10.1007/978-1-60761-524-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Irvin Vidrine J, Reitzel LR, Wetter DW. The role of tobacco in cancer health disparities. Curr Oncol Rep 2009; 11:475-81. [PMID: 19840525 DOI: 10.1007/s11912-009-0064-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although public health efforts have dramatically reduced the prevalence of smoking in the past several decades, smoking remains the leading cause of preventable morbidity and mortality in the United States. Moreover, tobacco use is becoming increasingly concentrated among individuals with the lowest levels of education, income, and occupational status. Profound racial/ethnic and socioeconomic status (SES) disparities exist for tobacco-related cancer incidence and mortality, and for access to and quality of cancer treatment. Furthermore, racial/ethnic minority and low SES smokers have greater difficulty quitting smoking, are less likely to use effective resources for quitting, and have limited access to evidence-based cessation treatments. Widespread implementation of population-based tobacco cessation approaches may have had the unintended effect of increasing tobacco-related cancer health disparities. It is crucial that vulnerable populations of smokers be provided with effective and accessible treatments for tobacco dependence, as this would have a profound impact on reducing tobacco-related cancer health disparities.
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Affiliation(s)
- Jennifer Irvin Vidrine
- Department of Health Disparities Research-Unit 1440, The University of Texas M. D. Anderson Cancer Center, PO BOX 301402, Houston, TX, 77230, USA.
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Improving Survival for Stage IV Non-small Cell Lung Cancer: A Surveillance, Epidemiology, and End Results Survey from 1990 to 2005. J Thorac Oncol 2009; 4:1524-9. [PMID: 19752759 DOI: 10.1097/jto.0b013e3181ba3634] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Leidner RS, Fu P, Clifford B, Hamdan A, Jin C, Eisenberg R, Boggon TJ, Skokan M, Franklin WA, Cappuzzo F, Hirsch FR, Varella-Garcia M, Halmos B. Genetic abnormalities of the EGFR pathway in African American Patients with non-small-cell lung cancer. J Clin Oncol 2009; 27:5620-6. [PMID: 19786660 DOI: 10.1200/jco.2009.23.1431] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Previous studies in non-small-cell lung cancer (NSCLC) have demonstrated a wide variation in responsiveness to epidermal growth factor receptor (EGFR) -targeting agents and in genetic aberrancies of the EGFR pathway according to ethnic background, most notably a higher frequency of activating EGFR mutations among East-Asian patients. We investigated the frequency of EGFR pathway aberrancies among African American patients with NSCLC, for whom limited information presently exists. PATIENTS AND METHODS EGFR fluorescent in situ hybridization (FISH) was performed on archived tissues from 53 African American patients. Extracted DNA was sequenced for mutational analysis of EGFR exons 18 to 21 and KRAS exon 2. Results were compared by multivariate analysis to an historical control cohort of 102 white patients with NSCLC. RESULTS African Americans were significantly less likely to harbor activating mutations of EGFR than white patients (2% v 17%; P = .022). Only one EGFR mutation was identified, a novel S768N substitution. EGFR FISH assay was more frequently positive for African Americans than for white patients (51% v 32%; P = .018). KRAS mutational frequency did not differ between the groups (23% v 21%; P = .409). CONCLUSION African American patients with NSCLC are significantly less likely than white counterparts to harbor activating mutations of EGFR, which suggests that EGFR tyrosine kinase inhibitors (TKIs) are unlikely to yield major remissions in this population. Our findings add to a growing body of evidence that points to genetic heterogeneity of the EGFR pathway in NSCLC among different ethnic groups and that underscores the need for consideration of these differences in the design of future trials of agents that target the EGFR pathway.
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Affiliation(s)
- Rom S Leidner
- Departments of Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Honma HN, De Capitani EM, Barbeiro ADS, Costa DB, Morcillo A, Zambon L. Polymorphism of the CYP1A1*2A gene and susceptibility to lung cancer in a Brazilian population. J Bras Pneumol 2009; 35:767-72. [PMID: 19750329 DOI: 10.1590/s1806-37132009000800008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 03/05/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To estimate and compare the frequency of CYP1A1*2A gene polymorphisms in a Brazilian population and determine the possible contribution of these genetic variations to lung cancer risk. METHODS: The study population included 200 patients with lung cancer, and the control group consisted of 264 blood donors. Genomic DNA was obtained from peripheral blood samples. The PCR-RFLP method was used for analysis of the CYP1A1*2A gene. RESULTS: There was no statistically significant difference between the lung cancer patients and the controls in terms of the distribution of CYP1A1*2A polymorphisms (p = 0.49). A multivariate logistic regression model analysis by ethnic group revealed that, within the lung cancer group, the CYP1A1*2A genotype CC plus TC was more common among the African-Brazilian patients than among the White patients (adjusted OR = 3.19; 95% CI: 1.53-6.65). CONCLUSIONS: The CYP1A1*2A gene cannot be linked with lung cancer risk in Brazilian patients at this time. Larger epidemiologic studies are needed in order to establish whether the CC plus TC polymorphism increases the risk of lung cancer in African-Brazilians.
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Improved survival from lung cancer in British Columbia compared to Scotland—Are different treatment rates the whole story? Lung Cancer 2009; 64:358-66. [DOI: 10.1016/j.lungcan.2008.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2008] [Revised: 10/02/2008] [Accepted: 10/04/2008] [Indexed: 12/25/2022]
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Videtic GMM, Reddy CA, Chao ST, Rice TW, Adelstein DJ, Barnett GH, Mekhail TM, Vogelbaum MA, Suh JH. Gender, race, and survival: a study in non-small-cell lung cancer brain metastases patients utilizing the radiation therapy oncology group recursive partitioning analysis classification. Int J Radiat Oncol Biol Phys 2009; 75:1141-7. [PMID: 19327899 DOI: 10.1016/j.ijrobp.2008.12.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 12/12/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To explore whether gender and race influence survival in non-small-cell lung cancer (NSCLC) in patients with brain metastases, using our large single-institution brain tumor database and the Radiation Therapy Oncology Group recursive partitioning analysis (RPA) brain metastases classification. METHODS AND MATERIALS A retrospective review of a single-institution brain metastasis database for the interval January 1982 to September 2004 yielded 835 NSCLC patients with brain metastases for analysis. Patient subsets based on combinations of gender, race, and RPA class were then analyzed for survival differences. RESULTS Median follow-up was 5.4 months (range, 0-122.9 months). There were 485 male patients (M) (58.4%) and 346 female patients (F) (41.6%). Of the 828 evaluable patients (99%), 143 (17%) were black/African American (B) and 685 (83%) were white/Caucasian (W). Median survival time (MST) from time of brain metastasis diagnosis for all patients was 5.8 months. Median survival time by gender (F vs. M) and race (W vs. B) was 6.3 months vs. 5.5 months (p = 0.013) and 6.0 months vs. 5.2 months (p = 0.08), respectively. For patients stratified by RPA class, gender, and race, MST significantly favored BFs over BMs in Class II: 11.2 months vs. 4.6 months (p = 0.021). On multivariable analysis, significant variables were gender (p = 0.041, relative risk [RR] 0.83) and RPA class (p < 0.0001, RR 0.28 for I vs. III; p < 0.0001, RR 0.51 for II vs. III) but not race. CONCLUSIONS Gender significantly influences NSCLC brain metastasis survival. Race trended to significance in overall survival but was not significant on multivariable analysis. Multivariable analysis identified gender and RPA classification as significant variables with respect to survival.
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Affiliation(s)
- Gregory M M Videtic
- Department of Radiation Oncology, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, OH 44195, USA.
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Kim AW, Liptay MJ, Higgins RS. A Contemporary Review on the Inequities in the Management of Lung Cancer among the African-American Population. J Natl Med Assoc 2008; 100:683-8. [DOI: 10.1016/s0027-9684(15)31342-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Davis KK, Lilienfeld DE, Doyle RL. Increased mortality in African Americans with idiopathic pulmonary arterial hypertension. J Natl Med Assoc 2008; 100:69-72. [PMID: 18277811 DOI: 10.1016/s0027-9684(15)31177-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Idiopathic pulmonary arterial hypertension (IPAH) is a progressive disorder that usually culminates in right ventricular failure and death without treatment. OBJECTIVE To assess mortality trends by race and gender for idiopathic pulmonary arterial hypertension in the United States from 1994-1998. METHODS The U.S. National Center for Health Statistics data for the years 1994-1998 was reviewed for deaths in which the underlying cause was primary pulmonary hypertension (ICD-9 code 416.0), now known as IPAH. The age, gender, race and state of residence of the deceased were abstracted from the Centers for Disease Control Wonder System (http://wonder.cdc.gov). Average annual age-adjusted region-, race- and gender-specific rates were then calculated. RESULTS African-American women demonstrated the highest mortality rates for IPAH across all age groups compared to other racial and gender groups. No geographical differences in mortality rates were noted. An increase in mortality rates with advancing age was observed in all racial and gender groups, with the highest mortality rates for IPAH noted in the elderly. DISCUSSION African Americans with IPAH exhibit a substantially increased mortality compared with Caucasians, particularly African-American women.
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Affiliation(s)
- Kala K Davis
- Division of Pulmonary/Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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44
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Race, Occupation, and Lung Cancer: Detecting Disparities With Death Certificate Data. J Occup Environ Med 2007; 49:1257-63. [DOI: 10.1097/jom.0b013e318154c094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Erridge SC, Møller H, Price A, Brewster D. International comparisons of survival from lung cancer: pitfalls and warnings. ACTA ACUST UNITED AC 2007; 4:570-7. [PMID: 17898807 DOI: 10.1038/ncponc0932] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2007] [Accepted: 05/14/2007] [Indexed: 12/25/2022]
Abstract
Population-based survival data can provide valuable comparative data on outcome but should be interpreted with caution. Differences in data collection and analysis, patient and tumor characteristics and treatment options can have an impact on reported results. Ideally, data from the whole population, including clinical-only diagnoses, should be reported and the methods of case identification described. The relative survival rates should preferably be given. Data on patient characteristics such as age, sex, ethnicity and socioeconomic deprivation should be described, together with tumor details such as pathology and clinical stage. Whenever possible, details on the use of treatments should be reported.
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Affiliation(s)
- Sara C Erridge
- Radiation Oncology at the University of Edinburgh and Edinburgh Cancer Centre, Edinburgh, UK.
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Wang SJ, Fuller CD, Thomas CR. Ethnic disparities in conditional survival of patients with non-small cell lung cancer. J Thorac Oncol 2007; 2:180-90. [PMID: 17410040 DOI: 10.1097/jto.0b013e318031cd4e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Conditional survival (CS) is an accurate estimate of survival probability for patients who have already survived at least 1 year after diagnosis. The purpose of this study was to determine whether ethnicity plays a role in 5-year CS rates for patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Using the Surveillance, Epidemiology, and End Results database, we analyzed 96,480 patients with NSCLC diagnosed between 1988 and 1995. Patients were divided into five ethnic groups: White (non-Hispanic), Hispanic, African American, Asian/Pacific Islander, and Native American/Alaskan. Using the life table method, we computed observed 5-year CS rates for patients who had already survived up to 5 years after diagnosis. Results were analyzed by stage, age, sex, and histology. RESULTS In general, 5-year CS rates increase for all ethnicities as time from diagnosis increases, but African Americans continued to have lower CS rates compared with other ethnic groups, even up to 5 years from diagnosis. When analyzed by stage, Hispanics with stage IV disease showed the greatest improvement in CS rate, increasing to 73% at 5 years from diagnosis. Among patients older than 70 years, African Americans had the lowest CS at 5 years--only 28%, compared with 40% to 47% for other groups. When analyzed by histology, Hispanics with large cell carcinoma had the worst CS rate (35% at 5 years). CONCLUSION For patients with NSCLC surviving a period of time after diagnosis, 5-year CS rates vary by ethnicity. CS can provide accurate prognostic information for patients with NSCLC who have already survived several years after diagnosis.
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Affiliation(s)
- Samuel J Wang
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon 97239-3098, USA.
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Abidoye O, Ferguson MK, Salgia R. Lung carcinoma in African Americans. ACTA ACUST UNITED AC 2007; 4:118-29. [PMID: 17259932 DOI: 10.1038/ncponc0718] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 09/18/2006] [Indexed: 11/09/2022]
Abstract
Lung carcinoma is the most commonly diagnosed cancer and the leading cause of cancer deaths in the US. It accounts for 12% of all cancers diagnosed worldwide, making it the most common malignancy, other than nonmelanoma skin cancer. A new focus has emerged involving the role of race and ethnicity in lung carcinoma. Current health statistics data demonstrate striking disparities, which are most evident between African American patients and their white counterparts. This disparity is greatest among male patients, where statistically significant differences are seen not only in lung cancer incidence and risk, but also in survival and treatment outcomes. Several hypotheses that attempt to explain this disparity include genetic, cultural and socioeconomic differences, in addition to differences in tobacco use and exposure. Current evidence does not clearly identify the reasons for this observed disparity, or the role the aforementioned factors play in the development and overall outcomes of people with lung cancer in these populations. This disease continues to pose a considerable public health burden and more research is needed to improve understanding of the disparity of lung carcinoma statistics among African Americans. This review summarizes the existing body of knowledge regarding lung carcinoma in African Americans and attempts to identify promising areas for future investigation and intervention.
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Affiliation(s)
- Oyewale Abidoye
- Hematology and Oncology, University of Chicago, Chicago, IL 60637, USA
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Flenaugh EL, Henriques-Forsythe MN. Lung cancer disparities in African Americans: health versus health care. Clin Chest Med 2006; 27:431-9, vi. [PMID: 16880053 DOI: 10.1016/j.ccm.2006.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
African Americans with lung cancer have disproportionately worse outcomes than other ethnic groups. The incidence of lung cancer in blacks has remained well above the rates seen for the general population and the 5-year and overall survival rates for blacks with lung cancer are among the lowest of all racial groups. Many studies have focused on socioeconomic status of African Americans as the sole cause of these disparities. Other stu-dies, however, have identified additional factors related to risks for poor outcomes in blacks with lung cancer. This article reviews data on these risks and their relationships to the health and health care of African Americans with lung cancer.
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Affiliation(s)
- Eric L Flenaugh
- Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, USA.
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Larson JL, Ahijevych K, Gift A, Hoffman L, Janson SL, Lanuza DM, Leidy NK, Meek P, Roberts J, Weaver T, Yoos HL. American Thoracic Society statement on research priorities in respiratory nursing. Am J Respir Crit Care Med 2006; 174:471-8. [PMID: 16894018 DOI: 10.1164/rccm.200409-1300st] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lederer DJ, Caplan-Shaw CE, O'Shea MK, Wilt JS, Basner RC, Bartels MN, Sonett JR, Arcasoy SM, Kawut SM. Racial and ethnic disparities in survival in lung transplant candidates with idiopathic pulmonary fibrosis. Am J Transplant 2006; 6:398-403. [PMID: 16426327 DOI: 10.1111/j.1600-6143.2005.01205.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Minority patients have worse outcomes than nonminority patients in a variety of pulmonary diseases. We aimed to compare the survival of Black and Hispanic patients to that of others with idiopathic pulmonary fibrosis (IPF). We performed a retrospective cohort study of patients with IPF who were evaluated for lung transplantation at our center. Kaplan-Meier survival curves and Cox proportional hazards models were used to compare survival between groups. Black and Hispanic patients had spirometry, lung volumes and diffusion capacity that were similar to others, but had worse exercise capacity. Minority patients had a significantly increased risk of death compared to others independent of transplantation status (hazard ratio = 3.3, 95% CI 1.2-8.9, p = 0.02). Differences in exercise capacity, pulmonary hemodynamics and socioeconomic factors appeared to account for some of the differences in survival. Black and Hispanic patients with IPF had an increased risk of death following referral for lung transplantation. This finding may be due to differences in disease progression and/or differences in access to medical care among minority patients. Future studies should confirm our findings in a larger cohort. The elimination of racial and ethnic disparities in outcome should be a priority for clinicians and researchers in this field.
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Affiliation(s)
- D J Lederer
- Department of Medicine, College of Physicians and Surgeon, Columbia University, New York, New York
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