Researchers have ruled out race as a prognostic factor for overall survival (OS) in black patients with a lung cancer diagnosis. In fact, a review of data showed that while black patients treated for lung cancer had shorter median OS than white patients and patients of other races, the type of treatment received and the stage of disease at diagnosis more likely accounted for the disparity. Data were presented at the Third American Association for Cancer Research Conference on the Science of Cancer Health Disparities.
“It has been widely thought that the malignant process in most types of cancer is biologically more aggressive in black patients than in white patients,” said lead investigator Rajesh Sehgal, MD, a medical oncologist and hematologist at the Edwards Comprehensive Cancer Center in Huntington, West Virginia. “We believe that our results show that if we compensate for all the factors which can affect survival in lung cancer patients, black patients do not have a worse prognosis compared to white patients.” He added that previous investigations of how race affects outcomes in patients with lung cancer patients often failed to account for other factors that might influence OS.
The investigators reviewed data from the Cancer Information Resource File (CIRF) pertaining to 130,517 patients who received a diagnosis of lung cancer between 2003 and 2008. CIRF contains data on patients from >350 hospitals nationwide.
Overall, 91.4% of the study population comprised white patients, 6.5% of patients were black, and 2.1% were other races. “Other” was defined as any patient who was neither white nor black. Black patients were more likely to have advanced metastatic disease at presentation than white patients (44% vs 41%, respectively).
For white patients, median OS was 10.3 months compared with 11.8 months for the “other” group and 9.1 months for black patients. Sehgal noted that treatments varied among the groups, with 28% of white patients and 28% of patients categorized as “other” undergoing surgical resection for their disease versus only 21% of black patients. This translated to a 60% reduced risk of death for patients who had surgery. Those patients who also received chemotherapy had a 43% reduction in the risk of death.
According to Sehgal, race was an independent predictor of OS for “other” races when compared with white patients (hazard ratio [HR], 0.86), but it was not relevant when comparing black patients with white patients (HR, 1.01). The analysis also found that patients with bronchoalveolar lung histology had a more favorable prognosis than those with other histologies.
“Our study has clinical, research, and public health implications,” Sehgal said. “The clinical implications are that we don’t need to treat lung cancer in black patients as a different entity than lung cancer in white patients…Black lung cancer patients can be told that their prognosis is similar [to that of] white patients if treated similarly.”
He called the public health implications obvious and important. “The racial differences in the median OS rates of lung cancer patients—which are probably due to treatment differences—also suggest possible differences in healthcare access, socioeconomic status, and medical insurance, and the presence of comorbidities.” Sehgal said all these factors need to be examined and addressed if necessary, in an effort to improve prognosis for black patients with lung cancer. He said from a research standpoint, the findings indicate that resources should not be wasted on performing studies to search for biologic differences between white and black patients with lung cancer that might drive prognosis.