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. 2025 Apr 19;61(4):753.
doi: 10.3390/medicina61040753.

Variability in Survival Outcomes Among Asian Ethnic Groups with Stage IV NSCLC

Aria Bassiri  1 , Yue-Lin Hu  2 , Christina Boutros  1 , Boxiang Jiang  1 , Jillian Sinopoli  1 , Leonidas Tapias Vargas  1 , Philip A Linden  1 , Christopher W Towe  1
Affiliations

Variability in Survival Outcomes Among Asian Ethnic Groups with Stage IV NSCLC

Aria Bassiri et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Patients of Asian descent are often grouped together despite their diverse ethnicities and genetic backgrounds. Cancer outcomes result from a complex interplay of genetics, environment, and socioeconomic factors. This study aims to describe lung cancer survival outcome variations in Asian ethnic subgroups, hypothesizing that significant outcome differences exist between subgroups. Materials and Methods: A retrospective analysis of the 2020 National Cancer Database identified patients with stage IV non-small-cell lung cancer (NSCLC). Asian patients were subcategorized into nine groups: Chinese, Japanese, Korean, Asian Indian/Pakistani, Vietnamese, Pacific Islander, Filipino, Laotian/Hmong/Kampuchean/Thai, and Other Asian/Asian not otherwise specified (NOS). The primary outcome was overall survival, and the secondary outcome was utilization of palliative care. Kaplan-Meier analysis and multivariate Cox and logistic modeling were used to assess outcomes of interest. Results: A total of 23,747 Asian patients with stage IV NSCLC were identified. Demographic characteristics of the subgroups varied by age, sex, Charlson-Deyo Comorbidity Index, and utilization of palliative care. Relative to Chinese Asians, multivariate Cox analysis showed worse survival outcomes among patients categorized as Japanese, Korean, Pacific Islanders, Filipino, and Laotian/Hmong/Kampuchean/Thai. The rate of palliative care utilization also varied among Asian subgroups. Compared to Chinese patients, palliative care was more likely to be utilized by patients categorized as Japanese and Pacific Islander. Conclusions: Amongst Asian subgroups, variations in survival outcomes and palliative care utilization in stage IV NSCLC patients were observed. Surgeons should acknowledge these disparities and consider disaggregating Asian races in prognosis analysis to enhance understanding of race's impact on outcomes. Recognizing these differences is crucial for guiding personalized treatment strategies, optimizing resource allocation, and informing health policy to ensure equitable cancer care for all Asian populations.

Keywords: Asian; lung cancer; race; stage IV; survival.

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Conflict of interest statement

All authors have completed the Journal of International Clinical Oncology conflict of interest disclosure statement form. CW Towe reports that he is a consultant for Zimmer Biomet, Astra Zeneca, Bristol Myers Squibb, Atricure, and Medtronic and is a grant recipient for the Zimmer Biomet and Intuitive Foundation. None of these relationships have affected this manuscript or the accuracy of the data analysis. The other authors have no disclosures, sources of funding, or financial relationships to declare.

Figures

Figure 1
Figure 1
Retrospective database analysis of the 2020 National Cancer Database of Asian patients with Stage IV non-metastatic, non-small-cell lung cancer. Distribution of Asian subgroup among the larger cohort of Asian patients. NOS—not otherwise specified.
Figure 2
Figure 2
Distribution of Asian subgroups with Stage IV non-metastatic, non-small-cell lung cancer from 2004 to 2020 in the National Cancer Database. NOS—not otherwise specified.
Figure 3
Figure 3
Kaplan–Meier survival analysis among different subgroups of Asian patients with stage IV non-small-cell lung cancer from 2004 to 2020 in the National Cancer Database.
See this image and copyright information in PMC

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