Differences in treatment and outcomes of non-small cell lung cancer (NSCLC) in Louisiana compared to the rest of the United States: A National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) analysis
Authors: V. Velcheti, V. Thumma, M. Matrana, J. T. Cole
Journal: Journal of Clinical Oncology (2008)

17507 Background: We investigated disparities in receipt of treatment, and survival among patients with non-small cell lung cancer in Louisiana cancer registry (LCR) compared to the rest of the nation (RON). Methods: We selected all patients with NSCLC in the SEER registries (2000 to 2004). Variables analyzed included age, gender, SEER geographic region, race, disease stage, histology, and treatment. The 5-year survival rates were calculated (SEER*Stat 6.3.6 version) for LCR and RON within each category of the American Joint Committee on Cancer (AJCC) staging system. Results: In the SEER registries, a total of 136,343 patients were identified with a diagnosis of NSCLC (2000–2004) of these 10,795 were reported by the LCR. We found significant demographic differences in LCR compared to the RON. Patients in LCR had higher proportions of men (62.13% vs. 55.58%) (p < 0.0001) and African- Americans (26.26% vs. 9.36%) (p < 0.0001). There were no significant differences in the tumor AJCC stage. However, we noted significant differences in the treatment delivered. Only 58.32% (vs. 72.23% in RON) (p < 0.0001) of early-stage (1 & 2) NSCLC patients in LCR underwent resection. The overall survival was worse in patients from LCR in all stages. This difference was most prominent in early stage NSCLC (5-year survival - 36.7% vs. 50.7%). Conclusions: The poorer survival in patients with NSCLC in LCR could be due to underuse of potentially curative surgery. Due to the observational nature of the data, we cannot completely explain why such differences in treatment exist. There seems to be a need for decreasing barriers to healthcare access related to recipient and the system. These findings merit further investigation. Differences in presentation, treatment, and outcomes of NSCLC in LCR compared to RON Louisiana cancer registry [2000+] Rest of SEER registries [2000+] Total Number 10795 125548 Gender Male (%) 6,707 (62.13%) 69,791 (55.58%) Female (%) 4,088 (37.87%) 55,757 (44.42%) Race Caucasian 7,893 (73.12%) 105,830 (84.30%) African American 2,834 (26.26%) 11,754 (9.36%) Other 68 (0.62%) 7,964 (6.34%) Median age at diagnosis 68 70 Histology Adenocarcinoma 4,123 (39.13%) 57,258 (45.61%) Squamous Cell Carcinoma 3,643 (33.24%) 34,422 (27.43%) Large Cell Carcinoma 1,144 (10.39%) 7,049 (5.61%) Non-Small Cell Carcinoma 1,885 (17.24%) 26,809 (21.35%) Tumor stage Stage 1 & 2 2,989 (27.69%) 36,047 (28.71%) Stage 3 & 4 7,806 (72.31%) 89,501 (71.29%) Treatment Stage 1 & 2 [Resectable] Surgery Yes 1,743 (58.32%) 26,037 (72.23%) No 1,240 (41.48%) 9,860 (27.35%) Unknown 6 (0.20%) 150 (0.42%) Stage 3 & 4 [Advanced] Surgery alone 355 (4.54%) 7,509 (8.39%) Surgery + Radiation 438 (5.61%) 6,984 (7.81%) Radiation alone 4,043 (51.80%) 36,418 (40.69%) No therapy 2,954 (37.85%) 38,269 (42.76%) Unknown 16 (0.20%) 321 (0.35%) Overall Survival: All stages 1-year survival 41.8% 45.5% 3-year survival 19.3% 24.1% 5-year survival 13.3% 18.7% Stage 1 & 2 [Resectable] 1-year survival 76.0% 81% 3-year survival 48.8% 60.4% 5-year survival 36.7% 50.7% Stage 3 & 4 1-year survival 29.9% 32.7% 3-year survival 9.1% 10.8% 5-year survival - - No significant financial relationships to disclose.