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. 2018 May 14:8:146.
doi: 10.3389/fonc.2018.00146. eCollection 2018.

The Role of Race and Economic Characteristics in the Presentation and Survival of Patients With Surgically Resected Non-Small Cell Lung Cancer

John M Varlotto  1   2 , Kerri McKie  2 , Rickie P Voland  3 , John C Flickinger  4 , Malcolm M DeCamp  5 , Debra Maddox  6 , Paul Stephen Rava  1   2 , Thomas J Fitzgerald  1   2 , William Walsh  2   6 , Paulo Oliveira  2   7 , Negar Rassaei  8 , Jennifer Baima  2   9 , Karl Uy  2   10
Affiliations

The Role of Race and Economic Characteristics in the Presentation and Survival of Patients With Surgically Resected Non-Small Cell Lung Cancer

John M Varlotto et al. Front Oncol. .

Abstract

Background: Little is understood regarding the inter-relation between economic, marital, and racial/ethnic differences in presentation and survival of surgically resected lung cancer patients. Our investigation will assess these differences in addition to known therapeutic, patient, and histopathologic factors.

Methods: A retrospective review of the Surveillance Epidemiology and End Reporting database was conducted through the years 2007-2012. The population was split into nine different ethnic groups. Population differences were assessed via chi-square testing. Multivariable analysis (MVA) were used to detect overall survival (OS) differences in the total surgical population (TS, N = 35,689) in an ear (T1-T2 < 4 cm N0) surgical population [early-stage resectable (ESR), N = 17,931]. Lung cancer-specific survival (LCSS) was assessed in the ESR.

Results: In the TS population, as compared to Whites, Blacks, and Hispanics presented with younger age, more adenocarcinomas, lower rates of marriage, lower rates of insurance, less stage I tumors, and had less nodes examined, but their type of surgical procedures and OS/LCSS were the same. MVA demonstrated that lower OS and LCSS were associated with males, single/divorced/widowed partnership, lower income (TS only), and Medicaid insurance. MVA also found that Blacks and Hispanics had a similar OS/LCSS to Whites and that all ethnic groups were associated with a similar or better outcomes. The 90-day mortality and positive nodes were correlated with not having insurance and not being married, but they were not associated with ethnicity.

Conclusion: In TS and ESR groups, OS was not different in the two largest ethnic groups (Black and Hispanic) as compared to Whites, but was related to single/widowed/divorced status, Medicaid insurance, and income (TS group only). Nodal positivity was associated with patients who did not have a married partner or insurance suggesting that these factors may impact disease biology. Economic and psychosocial variables may play a role in survival of ear lung cancer in addition to standard histopathologic and treatment variables.

Keywords: lung cancer; marital status; racial differences; socioeconomic status; surgical resection.

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Figures

Figure 1
Figure 1
(A) Unadjusted overall survival (OS) by ethnic group in the TS population. (B) Multivariable adjusted OS by ethnic group in the TS population.
Figure 2
Figure 2
Multivariable adjusted overall survival by insurance type in TS population.
Figure 3
Figure 3
(A,B) Multivariable adjusted overall survival and lung cancer-specific survival in the early-stage resectable population by marital status.
See this image and copyright information in PMC

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