Appropriateness of Surgical Approach in Black Patients with Lung Cancer-15 Years Later, Little Has Changed

Abstract

Introduction: Black patients with lung cancer receive an operation less often and have worse survival than white patients. Over the past several decades limited resection has become an acceptable alternative to lobectomy in selected cases, and mediastinal lymph node staging is recommended. The Surveillance, Epidemiology, and End Results database was explored to assess whether the type of surgical approach is similar in black and white patients with lung cancer.

Methods: All cases of pathologically proven lung cancers within the site code International Classification of Diseases for Oncology, Third Edition, C340 to C349 (67,191 whites and 13,387 blacks), age 64 years or younger, diagnosed between 2007 and 2012 were identified. The odds of treatment (operation or radiation) in blacks versus whites were calculated using multivariable logistic regression, with race as the dependent variable, overall and by disease stage.

Results: Surgical treatment was significantly less likely to be administered to black patients than to white patients overall (OR_adjusted [OR_adj] = 0.69, 95% confidence interval [CI]: 0.65-0.74) and according to stage. Opposite results were observed when radiation was analyzed (OR_adj = 1.1, 95% CI: 1.04-1.12). Stratification by age groups (≤50 years versus >50 years) or insurance status did not influence the results. Among those who underwent a surgical procedure, black patients were less likely to have their lymph nodes resected overall (OR_adj = 0.79, 95% CI: 0.7-0.89) and according to stage.

Conclusions: Racial disparities in appropriate lung cancer treatment are still observed independently from insurance status.

Keywords: Epidemiology; Limited resection; Lobectomy; Lymph node resection.