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J Thorac Oncol. 2018 Oct;13(10):1464-1473. doi: 10.1016/j.jtho.2018.05.032. Epub 2018 Jun 6.

Racial Disparities in Lung Cancer Survival: The Contribution of Stage, Treatment, and Ancestry.

Author information

1
Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee.
2
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
3
Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
4
Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Tennessee Valley Health System Veterans Affairs, Nashville, Tennessee.
5
Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, Tennessee.
6
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
7
Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
8
Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: melinda.aldrich@vumc.org.

Abstract

INTRODUCTION:

Lung cancer is a leading cause of cancer-related death worldwide. Racial disparities in lung cancer survival exist between blacks and whites, yet they are limited by categorical definitions of race. We sought to examine the impact of African ancestry on overall survival among blacks and whites with NSCLC cases.

METHODS:

Incident cases of NSCLC in blacks and whites from the prospective Southern Community Cohort Study (N = 425) were identified through linkage with state cancer registries in 12 southern states. Vital status was determined by linkage with the National Death Index and Social Security Administration. We evaluated the impact of African ancestry (as estimated by using genome-wide ancestry-informative markers) on overall survival by calculating the time-dependent area under the curve (AUC) for Cox proportional hazards models, adjusting for relevant covariates such as stage and treatment. We replicated our findings in an independent population of NSCLC cases in blacks.

RESULTS:

Global African ancestry was not significantly associated with overall survival among NSCLC cases. There was no change in model performance when Cox proportional hazards models with and without African ancestry were compared (AUC = 0.79 for each model). Removal of stage and treatment reduced the average time-dependent AUC from 0.79 to 0.65. Similar findings were observed in our replication study.

CONCLUSIONS:

Stage and treatment are more important predictors of survival than African ancestry is. These findings suggest that racial disparities in lung cancer survival may disappear with similar early detection efforts for blacks and whites.

KEYWORDS:

Disparities; Genetic ancestry; Lung cancer; Race; Survival

PMID:
29885480
PMCID:
PMC6153049
[Available on 2019-10-01]
DOI:
10.1016/j.jtho.2018.05.032

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