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

Melissa AL Vyfhuis, Neha Bhooshan, Jason Molitoris, Søren M. Bentzen, Josephine Feliciano, Martin Edelman, Whitney M. Burrows, Elizabeth M. Nichols, Mohan Suntharalingam, James Donahue, Marc Nagib, Shamus R. Carr, Joseph Friedberg, Shahed Badiyan, Charles B. Simone, Steven J. Feigenberg, Pranshu Mohindra

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives The 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 Methods A 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. Results Black 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. Conclusions We 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.

Original languageEnglish (US)
Pages (from-to)44-49
Number of pages6
JournalLung Cancer
Volume114
DOIs
StatePublished - Dec 2017

Keywords

  • Bimodality
  • Black patients
  • Disparities
  • Non–small cell lung cancer (NSCLC)
  • Stage III
  • Trimodality treatment

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

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