Lung Cancer: Lung Cancer Screening in the Real World |

Early-Stage Non-small Cell Lung Cancer in Asian-Americans in the National Lung Screening Trial FREE TO VIEW

Jordan Lee, MD; Lindsay Yang, MS; Alex Balekian, MD
Author and Funding Information

Division of Pulmonary, Critical Care, and Sleep Medicine; Keck School of Medicine, University of Southern California, Los Angeles, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):729A. doi:10.1016/j.chest.2016.08.824
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SESSION TITLE: Lung Cancer Screening in the Real World

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 04:30 PM - 05:30 PM

PURPOSE: Prior studies have shown that African-American patients in the Medicare population with early-stage non-small cell lung cancer (NSCLC) have lower cancer-specific survival (CSS) than do Caucasian patients, and this difference has been attributed to lower rates of curative surgery in African-Americans. Asians have been reported to have better CSS than Caucasians, but these studies have examined primarily colon, breast, and prostate cancer patients. Because no direct comparisons between Asians and Caucasians exist in prospective lung cancer clinical trials, we aimed to describe care patterns in Asian-American patients with early-stage NSCLC and to identify any differences in CSS as part of the National Lung Screening Trial (NLST).

METHODS: We performed a secondary analysis of NLST data and identified all clinical stage I (T1N0M0) NSCLC patients who underwent recommended care. Recommended care was defined as curative surgery within 90 days or radiation within 120 days of diagnosis; for those upstaged on definitive staging, we defined recommended care as adjuvant chemotherapy within 120 days for Stage II, adjuvant chemotherapy plus radiation within 120 days for stage III, and adjuvant chemotherapy within 90 days without radiation for Stage IV. In the case of multiple cancers in the same patient, we included only the first case. Patient race was self-reported as Caucasian, African-American, Asian (including Pacific Islander and Native Hawaiian), and other/mixed. Covariates included age at diagnosis, sex, personal history of COPD, and definitive stage. Using multivariate logistic regression, we identified variables associated with treatment compliance; using Cox proportional hazards, we identified variables associated with cancer-specific mortality.

RESULTS: During the follow-up period, 1803 patients were diagnosed with NSCLC. There were 769 Stage I patients, of which 700 (91%) were Caucasian, 38 (4.9%) were African-American, 19 (2.5%) were Asian, and 12 (1.6%) were other; ultimately, definitive staging showed 650 (85%) in Stage I, 65 (8%) in Stage II, 44 (6%) in Stage III, and 10 (1%) in Stage IV. Asian-American patients received recommended care similar to Caucasian patients (89.5% vs 89.1%, p=0.99). After adjustment, receipt of recommended care among Asians remained similar when compared to Caucasians (OR 0.97, p=0.55). When compared to Caucasians, Asian-Americans had similar cancer-specific mortality [HR 0.58, 95%CI (0.18-1.85), p=0.36] after adjustment for covariates.

CONCLUSIONS: In early-stage NSCLC patients participating in the NLST, Asian-Americans receive recommended care at rates similar to those of Caucasians. Although their cancer-specific survival appears somewhat better, it did not meet statistical significance, possibly due to low sample size.

CLINICAL IMPLICATIONS: Asian-American patients appear to be compliant with undergoing guideline-recommended care for NSCLC. Any possible improved cancer-specific mortality might be due to underlying genetic factors. More studies with larger proportions of Asian patients are needed.

DISCLOSURE: The following authors have nothing to disclose: Jordan Lee, Lindsay Yang, Alex Balekian

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