Clinical outcomes of black vs. non-black patients with locally advanced non–small cell lung cancer

Abstract

ObjectivesThe black population remains underrepresented in clinical trials despite reports suggesting greater incidence and deaths from locally advanced non-small cell lung cancer (NSCLC). We determined outcomes for black and non-black patients in a well-annotated cohort treated with either definitive chemoradiation (CRT; bimodality) or CRT followed by surgery (trimodality therapy). Materials and MethodsA retrospective analysis of 355 stage III NSCLC patients treated with curative intent at the University of Maryland, Medical Center, between January 2000-December 2013 was performed. The Kaplan–Meier approach and the Cox proportional hazards models were used to analyze overall survival (OS) and freedom-from-recurrence (FFR) in black and non-black patients. The chi-square test was used to compare categorical variables. ResultsBlack patients comprised 42% of the cohort and were more likely to be younger (p < 0.0001), male (p = 0.030), single (p < 0.0001), reside in lower household income zipcodes (p < 0.0001), have an Eastern Cooperative Oncology Group (ECOG) performance status >0 (p < 0.001), and less likely to undergo surgery (p < 0.0001). With a median follow-up of 15 months for all patients and 89 months for surviving patients (range:1–186 months), median OS times for black and non-black patients were 22 and 24 months, respectively (p = 0.698). FFR rates were also comparable between the two groups (p = 0.468). Surgery improved OS in both cohorts. Race was not a significant predictor for OS or FFR even when adjusted for other factors. ConclusionsWe found similar oncologic outcomes in black and non-black NSCLC patients when treated with curative intent in a comprehensive cancer center setting, despite epidemiologic differences in presentation and receipt of care. Future efforts to improve outcomes in black patients could focus on addressing modifiable social disparities.