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Shusted CS, Barta JA, Nguyen A, Wen KY, Juon HS, Zeigler-Johnson C. Characterizing Lung Cancer Burden Among Asian-American Communities in Philadelphia. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01723-1. [PMID: 37540304 DOI: 10.1007/s40615-023-01723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/08/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023]
Abstract
Lung cancer (LC) is the leading cause of cancer death among Asian-Americans. However, there are differences in LC incidence and mortality among Asian racial subgroups. The objective of this study was to describe LC burden and disparities among race/ethnic groups (White, Black, Asian, and Hispanic) across US census tracts (CT) in Philadelphia using the Pennsylvania Cancer Registry dataset (N=11,865). ArcGIS Pro was used to geocode patient addresses to the CT level for linkage to US Census data. Despite being diagnosed more frequently with advanced-stage lung cancer compared with other race and ethnic groups in Philadelphia, Asian patients were most likely to be alive at the time of data receipt. Among Asian subgroups, Korean patients were the oldest (median age 75, p=0.024). Although not statistically different, distant stage disease was the most prevalent among Asian Indian (77.8%) and Korean (73.7%) and the least prevalent among Chinese patients (49.5%). LC was the cause of death for 77.8% of Asian Indian, 63.2% of Korean, 52.9% of other Asian, 48.5% of Chinese, and 47.5% of Vietnamese patients. CTs where Asian individuals were concentrated had lower socioeconomic status and greater tobacco retailer density compared to the entire city. Compared to all of Philadelphia, heavily Asian CTs experienced a greater age-standardized LC incidence (1.48 vs. 1.42) but lower age-standardized LC mortality (1.13 vs. 1.22). Our study suggests that LC disparities exist among Asian subgroups, with Asian Indian and Korean Philadelphians most likely to present with advanced disease. Additional studies are needed to investigate LC among high-risk racial and ethnic groups, including Asian subgroups.
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Affiliation(s)
- Christine S Shusted
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Julie A Barta
- Division of Pulmonary and Critical Care Medicine, The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Anh Nguyen
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kuang-Yi Wen
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Hee-Soon Juon
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Charnita Zeigler-Johnson
- Fox Chase Cancer Center, Cancer Prevention and Control, 4141 Young Pavilion, 333 Cottman Avenue, Philadelphia, PA, USA.
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Patel PB, Alpert N, Taioli E, Flores R. Disparities in clinical and demographic characteristics among Asian/Pacific Islander and Non-Hispanic White newly diagnosed lung cancer patients. Cancer Causes Control 2022; 33:547-557. [PMID: 35043281 DOI: 10.1007/s10552-021-01548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Racial disparities persist among lung cancer patients but have not been adequately studied among Asian/Pacific Islander (API) subgroups, which are heterogeneous. This study compared clinical and demographic characteristics at diagnosis of API subgroups and NHW patients. METHODS NHW and API adults diagnosed with lung cancer were identified from the Surveillance, Epidemiology, and End Results database (1990-2015). API was divided into eight subgroups: Chinese, Japanese, Filipino, Hawaiian/Pacific Islander, Korean, Vietnamese, Asian Indian/Pakistani, and Other. Multivariable multinomial logistic regression models were used to assess adjusted associations of clinical and demographic factors with API/subgroups. RESULTS There were 522,702 (92.6%) NHW and 41,479 (7.4%) API lung cancer patients. API were less likely to be diagnosed at the age of ≥ 80 years (ORadj 0.53, 95% CI 0.48-0.58 for ≥ 80 vs. ≤ 39 years) than NHW. However, Japanese patients were more often diagnosed at ≥ 80 years compared to other ethnic subgroups. API were less often female (ORadj 0.85, 95% CI 0.83-0.86), and unmarried (ORadj 0.71, 95% CI 0.68-0.74); however, among API, Japanese, Hawaiian/Pacific Islander, Korean, and Vietnamese were more often unmarried, compared to Chinese patients. API were more frequently diagnosed at stage IV, compared to stage I (ORadj 1.31, 95% CI 1.27-1.35). API had significantly less squamous cell carcinoma (ORadj 0.54, 95% CI 0.52-0.56, compared to adenocarcinoma); among API, Japanese, Filipino, Hawaiian/Pacific Islander, Korean, Asian Indian/Pakistani, and Other were more likely than Chinese patients to present with squamous cell histology (range: ORadj[Other] 1.24, 95% CI 1.09-1.41; ORadj[Hawaiian/Pacific Islander] 2.47, 95% CI 2.22-2.75). CONCLUSION At diagnosis, there are significant differences in demographic and clinical characteristics between NHW, API, and API subgroups. Treating API patients as a single population may overlook biological, environmental, and behavioral differences that might be beneficial in designing prevention strategies and treatment.
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Affiliation(s)
- Parth B Patel
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naomi Alpert
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Price SN, Flores M, Hamann HA, Ruiz JM. Ethnic Differences in Survival Among Lung Cancer Patients: A Systematic Review. JNCI Cancer Spectr 2021; 5:pkab062. [PMID: 34485813 PMCID: PMC8410140 DOI: 10.1093/jncics/pkab062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/29/2021] [Accepted: 05/20/2021] [Indexed: 01/12/2023] Open
Abstract
Background Despite a substantially worse risk factor profile, Hispanics in the United States experience lower incidence of many diseases and longer survival than non-Hispanic Whites (NHWs), an epidemiological phenomenon known as the Hispanic Health Paradox (HHP). This systematic review evaluated the published longitudinal literature to address whether this pattern extends to lung cancer survival. Methods Searches of Medline, PubMed, Embase, Web of Science, and the Cochrane Library were conducted for publications dated from January 1, 2000, to July 18, 2018. Records were restricted to articles written in English, employing a longitudinal design, and reporting a direct survival comparison (overall survival [OS], cancer-specific survival [CSS]) between NHW and Hispanic lung cancer patients. Results A final sample of 29 full-text articles were included, with 28 fully adjusted models of OS and 21 of CSS included. Overall, 26 (92.9%) OS models and 20 (95.2%) CSS models documented either no difference (OS = 16, CSS = 11) or a Hispanic survival advantage (OS = 10, CSS = 9). Both larger studies and those including foreign-born Hispanics were more likely to show a Hispanic survival advantage, and 2 studies of exclusively no-smokers showed a survival disadvantage. A number of reporting gaps were identified including Hispanic background and sociodemographic characteristics. Conclusions Hispanics exhibit similar or better survival in the context of lung cancer relative to NHWs despite a considerably worse risk factor profile. These findings support the HHP in the context of lung cancer. Further research is needed to understand the potential mechanisms of the HHP as it relates to lung cancer.
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Affiliation(s)
- Sarah N Price
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Melissa Flores
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Center for Border Health Disparities, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA
| | - John M Ruiz
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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Nemesure B, Albano D, Nemesure A. Short- and long-term survival outcomes among never smokers who developed lung cancer. Cancer Epidemiol 2021; 75:102042. [PMID: 34571392 DOI: 10.1016/j.canep.2021.102042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death in the US. While an extensive literature exists detailing lung cancer risk factors and mortality among patients with a history of tobacco use, the data are more limited among individuals who have never smoked. The purpose of this investigation is to compare survival rates between the two groups and evaluate potential risk factors among never smokers. METHODS This retrospective study included 3380 smokers and 334 never smokers who were diagnosed with lung cancer at Stony Brook University Hospital between 2003 and 2016. 1-, 3-, 5- and 10-year survival outcomes, stratified by smoking status, were compared and Kaplan-Meier curves for overall survival are provided. Cox Proportional Hazard models were used to evaluate factors influencing survival among never smokers. RESULTS Never smokers with lung cancer were more likely to be female, be diagnosed with adenocarcinoma histology, and had fewer comorbidities than lung cancer patients who smoked. Although 60% of patients were diagnosed at a later stage of disease development, regardless of smoking status, overall short- and long-term survival was significantly higher among never smokers compared to those with a history of tobacco use. In addition to age and stage at diagnosis, a history of diabetes was found to be a significant prognostic factor for decreased survival among never smokers (HR=3.15, 95% CI (1.74, 5.71)). CONCLUSIONS Data from the present investigation suggest that, regardless of smoking status, approximately three of every five lung cancer patients are diagnosed at a later stage, and that both short- and long-term survival outcomes are significantly better among never smokers compared to those with a history of tobacco use. Additional studies are required to validate these findings and better explain the mechanistic drivers for the improved outcomes among never smokers.
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Affiliation(s)
- Barbara Nemesure
- Department of Family, Population and Preventive Medicine, Stony Brook Medicine, 100 Nicolls Road - Health Sciences Center, Level 3, Stony Brook, NY 11794-8036, United States.
| | - Denise Albano
- Department of Surgery, Stony Brook Medicine, 100 Nicolls Road - Health Sciences Center, Level 19, Stony Brook, NY 11794-8191, United States.
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DeRouen MC, Thompson CA, Canchola AJ, Jin A, Nie S, Wong C, Jain J, Lichtensztajn DY, Li Y, Allen L, Patel MI, Daida YG, Luft HS, Shariff-Marco S, Reynolds P, Wakelee HA, Liang SY, Waitzfelder BE, Cheng I, Gomez SL. Integrating Electronic Health Record, Cancer Registry, and Geospatial Data to Study Lung Cancer in Asian American, Native Hawaiian, and Pacific Islander Ethnic Groups. Cancer Epidemiol Biomarkers Prev 2021; 30:1506-1516. [PMID: 34001502 PMCID: PMC8530225 DOI: 10.1158/1055-9965.epi-21-0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/18/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A relatively high proportion of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) females with lung cancer have never smoked. We used an integrative data approach to assemble a large-scale cohort to study lung cancer risk among AANHPIs by smoking status with attention to representation of specific AANHPI ethnic groups. METHODS We leveraged electronic health records (EHRs) from two healthcare systems-Sutter Health in northern California and Kaiser Permanente Hawai'i-that have high representation of AANHPI populations. We linked EHR data on lung cancer risk factors (i.e., smoking, lung diseases, infections, reproductive factors, and body size) to data on incident lung cancer diagnoses from statewide population-based cancer registries of California and Hawai'i for the period between 2000 and 2013. Geocoded address data were linked to data on neighborhood contextual factors and regional air pollutants. RESULTS The dataset comprises over 2.2 million adult females and males of any race/ethnicity. Over 250,000 are AANHPI females (19.6% of the female study population). Smoking status is available for over 95% of individuals. The dataset includes 7,274 lung cancer cases, including 613 cases among AANHPI females. Prevalence of never-smoking status varied greatly among AANHPI females with incident lung cancer, from 85.7% among Asian Indian to 14.4% among Native Hawaiian females. CONCLUSION We have developed a large, multilevel dataset particularly well-suited to conduct prospective studies of lung cancer risk among AANHPI females who never smoked. IMPACT The integrative data approach is an effective way to conduct cancer research assessing multilevel factors on cancer outcomes among small populations.
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Affiliation(s)
- Mindy C DeRouen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Caroline A Thompson
- San Diego State University School of Public Health, San Diego, California
- University of California San Diego School of Medicine, San Diego, California
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Anqi Jin
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Sixiang Nie
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Carmen Wong
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Jennifer Jain
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Daphne Y Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Yuqing Li
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Laura Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Manali I Patel
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
- VA Palo Alto Health Care System, Palo Alto, California
| | - Yihe G Daida
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Harold S Luft
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Peggy Reynolds
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Su-Ying Liang
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Beth E Waitzfelder
- Kaiser Permanente Hawai'i Center for Integrated Health Care Research, Honolulu, Hawaii
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Fransisco, California
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Predict multicategory causes of death in lung cancer patients using clinicopathologic factors. Comput Biol Med 2020; 129:104161. [PMID: 33307409 DOI: 10.1016/j.compbiomed.2020.104161] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Random forests (RF) is a widely used machine-learning algorithm, and outperforms many other machine learning algorithms in prediction-accuracy. But it is rarely used for predicting causes of death (COD) in cancer patients. On the other hand, multicategory COD are difficult to classify in lung cancer patients, largely because they have multiple labels (versus binary labels). METHODS We tuned RF algorithms to classify 5-category COD among the lung cancer patients in the surveillance, epidemiology and end results-18, whose lung cancers were diagnosed in 2004, for the completeness in their follow-up. The patients were randomly divided into training and validation sets (1:1 and 4:1 sample-splits). We compared the prediction accuracy of the tuned RF and multinomial logistic regression (MLR) models. RESULTS We included 42,257 qualified lung cancers in the database. The COD were lung cancer (72.41%), other causes or alive (14.43%), non-lung cancer (6.85%), cardiovascular disease (5.35%), and infection (0.96%). The tuned RF model with 300 iterations and 10 variables outperformed the MLR model (accuracy = 69.8% vs 64.6%, 1:1 sample-split), while 4:1 sample-split produced lower prediction-accuracy than 1:1 sample-split. The top-10 important factors in the RF model were sex, chemotherapy status, age (65+ vs < 65 years), radiotherapy status, nodal status, T category, histology type and laterality, all of which except T category and laterality were also important in MLR model. CONCLUSION We tuned RF models to predict 5-category CODs in lung cancer patients, and show RF outperforms MLR in prediction accuracy. We also identified the factors associated with these COD.
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Deng F, Shen L, Wang H, Zhang L. Classify multicategory outcome in patients with lung adenocarcinoma using clinical, transcriptomic and clinico-transcriptomic data: machine learning versus multinomial models. Am J Cancer Res 2020; 10:4624-4639. [PMID: 33415023 PMCID: PMC7783755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023] Open
Abstract
Classification of multicategory survival-outcome is important for precision oncology. Machine learning (ML) algorithms have been used to accurately classify multi-category survival-outcome of some cancer-types, but not yet that of lung adenocarcinoma. Therefore, we compared the performances of 3 ML models (random forests, support vector machine [SVM], multilayer perceptron) and multinomial logistic regression (Mlogit) models for classifying 4-category survival-outcome of lung adenocarcinoma using the TCGA. Mlogit model overall performed similar to SVM and multilayer perceptron models (micro-average area under curve=0.82), while random forests model was inferior. Surprisingly, transcriptomic data alone and clinico-transcriptomic data appeared sufficient to accurately classify the 4-category survival-outcome in these patients, but no models using clinical data alone performed well. Notably, NDUFS5, P2RY2, PRPF18, CCL24, ZNF813, MYL6, FLJ41941, POU5F1B, and SUV420H1 were the top-ranked genes that were associated with alive without disease and inversely linked to other outcomes. Similarly, BDKRB2, TERC, DNAJA3, MRPL15, SLC16A13, CRHBP and ACSBG2 were associated with alive with progression and GAL3ST3, AD2, RAB41, HDC, and PLEKHG1 associated with dead with disease, respectively, while also inversely linked other outcomes. These cross-linked genes may be used for risk-stratification and future treatment development.
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Affiliation(s)
- Fei Deng
- School of Electrical and Electronic Engineering, Shanghai Institute of TechnologyShanghai, China
| | - Lanlan Shen
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children’s Nutrition Research CenterHouston, TX, USA
| | - He Wang
- Department of Pathology, Yale University School of MedicineNew Haven, CT, USA
| | - Lanjing Zhang
- Department of Pathology, Princeton Medical CenterPlainsboro, NJ, USA
- Department of Biological Sciences, Rutgers UniversityNewark, NJ
- Rutgers Cancer Institute of New JerseyNew Brunswick, NJ, USA
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers UniversityPiscataway, NJ, USA
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Amanam I, Mambetsariev I, Gupta R, Achuthan S, Wang Y, Pharaon R, Massarelli E, Koczywas M, Reckamp K, Salgia R. Role of immunotherapy and co-mutations on KRAS-mutant non-small cell lung cancer survival. J Thorac Dis 2020; 12:5086-5095. [PMID: 33145085 PMCID: PMC7578487 DOI: 10.21037/jtd.2020.04.18] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background KRAS mutations reported in non-small cell lung cancer (NSCLC) represent a significant percentage of patients diagnosed with NSCLC. However, there still remains no therapeutic option designed to target KRAS. In an era with immunotherapy as a dominant treatment option in metastatic NSCLC, the role of immunotherapy in KRAS mutated patients is not clear. Methods Eligible patients diagnosed with NSCLC and found to have a KRAS mutation were identified in an institutional lung cancer database. Demographic, clinical, and molecular data was collected and analyzed. Results A total of 60 patients were identified for this retrospective analysis. Majority of patients were Caucasian (73%), diagnosed with stage IV (70%) adenocarcinoma (87%), and had a KRAS codon 12 mutation (78%). Twenty percent of patients were treated with immunotherapy. Median overall survival was 28 months in the cohort and patients who received immunotherapy were found to have better survival versus those who did not (33 vs. 22 months, P=0.31). Furthermore, there was an association between high survival and patients who received immunotherapy (P=0.007). Conclusions Patients with KRAS mutations have a unique co-mutation phenotype that requires further investigation. Immunotherapy seems to be an effective choice of treatment for KRAS positive patients in any treatment-line setting and yields better outcomes than conventional chemotherapy. The relationship between immunotherapy and KRAS mutations requires further studies to confirm survival advantage.
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Affiliation(s)
- Idoroenyi Amanam
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Isa Mambetsariev
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Rohan Gupta
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Srisairam Achuthan
- Center for Informatics, City of Hope National Medical Center, Duarte, CA, USA
| | - Yingyu Wang
- Center for Informatics, City of Hope National Medical Center, Duarte, CA, USA
| | - Rebecca Pharaon
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Erminia Massarelli
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Marianna Koczywas
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Karen Reckamp
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA
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Lui NS, Benson J, He H, Imielski BR, Kunder CA, Liou DZ, Backhus LM, Berry MF, Shrager JB. Sub-solid lung adenocarcinoma in Asian versus Caucasian patients: different biology but similar outcomes. J Thorac Dis 2020; 12:2161-2171. [PMID: 32642121 PMCID: PMC7330405 DOI: 10.21037/jtd.2020.04.37] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Asian and Caucasian patients with lung cancer have been compared in several database studies, with conflicting findings regarding survival. However, these studies did not include proportion of ground-glass opacity or mutational status in their analyses. Asian patients commonly develop sub-solid lung adenocarcinomas that harbor EGFR mutations, which have a better prognosis. We hypothesized that among patients undergoing surgery for sub-solid lung adenocarcinomas, Asian patients have better survival compared to Caucasian patients. Methods We identified Asian and Caucasian patients who underwent surgical resection for a sub-solid lung adenocarcinoma from 2002 to 2015 at our institution. Sub-solid was defined as ≥10% ground-glass opacity on preoperative CT scan or ≥10% lepidic component on surgical pathology. Time-to-event multivariable analysis was performed to determine which characteristics were associated with recurrence and survival. Results Two hundred twenty-four patients were included with median follow up 48 months. Asian patients were more likely to be never smokers (76.3% vs. 29.0%, P<0.01) and have an EGFR mutation (69.4% vs. 25.6% of those tested, P<0.01), while Caucasian patients were more likely to have a KRAS mutation (23.5% vs. 4.9% of those tested, P<0.01). There was a trend towards Asian patients having a higher proportion of ground-glass opacity (38.8% vs. 30.5%, P=0.11). Time-to-event multivariable analysis showed that higher proportion of ground-glass opacity was significantly associated with better recurrence-free survival (HR 0.76 per 20% increase, P=0.02). However, mutational status and race did not have a significant impact on recurrence-free or overall survival. Conclusions Asian and Caucasian patients with sub-solid lung adenocarcinoma have different tumor biology, but recurrence-free and overall survival after surgical resection is similar.
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Affiliation(s)
- Natalie S Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Jalen Benson
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Hao He
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Bartlomiej R Imielski
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA.,Department of Surgery, Northwestern University, Chicago, IL, USA
| | | | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
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10
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Klugman M, Xue X, Hosgood HD. Race/ethnicity and lung cancer survival in the United States: a meta-analysis. Cancer Causes Control 2019; 30:1231-1241. [DOI: 10.1007/s10552-019-01229-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022]
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11
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Lung cancer survival among never smokers. Cancer Lett 2019; 451:142-149. [PMID: 30851418 DOI: 10.1016/j.canlet.2019.02.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/13/2019] [Accepted: 02/28/2019] [Indexed: 11/22/2022]
Abstract
Lung cancer incidence among never smokers has increased in recent decades with 10-30% of all lung cancers occurring in never smokers, where exposure to residential radon is the leading cause of this disease. Lung cancer survival is low, ranging from 12% to 16% at 5 years of diagnosis. There is scant evidence to date on survival from this disease in never smokers. We aim to evaluate lung cancer survival in never smokers and ascertain whether there might be differences regarding smokers, through a systematic review applying predefined inclusion and exclusion criteria. 17 Studies were included. Never-smoker lung cancer patients seem to experience longer survival times than do smokers or ex-smokers. Lung cancer in never smokers displays distinctive clinical characteristics, is more frequent among women, is diagnosed at more advanced stages, and the predominant histologic type is adenocarcinoma. Further studies are necessary to ascertain lung cancer survival among never smokers.
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Thompson CA, Boothroyd DB, Hastings KG, Cullen MR, Palaniappan LP, Rehkopf DH. A Multiple-Imputation "Forward Bridging" Approach to Address Changes in the Classification of Asian Race/Ethnicity on the US Death Certificate. Am J Epidemiol 2018; 187:347-357. [PMID: 29401361 DOI: 10.1093/aje/kwx215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/31/2017] [Indexed: 12/18/2022] Open
Abstract
The incomparability of old and new classification systems for describing the same data can be seen as a missing-data problem, and, under certain assumptions, multiple imputation may be used to "bridge" 2 classification systems. One example of such a change is the introduction of detailed Asian-American race/ethnicity classifications on the 2003 version of the US national death certificate, which was adopted for use by 38 states between 2003 and 2011. Using county- and decedent-level data from 3 different national sources for pre- and postadoption years, we fitted within-state multiple-imputation models to impute ethnicities for decedents classified as "other Asian" during preadoption years. We present mortality rates derived using 3 different methods of calculation: 1) including all states but ignoring the gradual adoption of the new death certificate over time, 2) including only the 7 states with complete reporting of all ethnicities, and 3) including all states and applying multiple imputation. Estimates from our imputation model were consistently in the middle of the other 2 estimates, and trend results demonstrated that the year-by-year estimates of the imputation model were more similar to those of the 7-state model. This work demonstrates how multiple imputation can provide a "forward bridging" approach to make more accurate estimates over time in newly categorized populations.
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Affiliation(s)
- Caroline A Thompson
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, California
- Sutter Health Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Derek B Boothroyd
- Quantitative Sciences Unit, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Katherine G Hastings
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Mark R Cullen
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - Latha P Palaniappan
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
| | - David H Rehkopf
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California
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Thompson CA, Gomez SL, Hastings KG, Kapphahn K, Yu P, Shariff-Marco S, Bhatt AS, Wakelee HA, Patel MI, Cullen MR, Palaniappan LP. The Burden of Cancer in Asian Americans: A Report of National Mortality Trends by Asian Ethnicity. Cancer Epidemiol Biomarkers Prev 2018; 25:1371-1382. [PMID: 27694108 DOI: 10.1158/1055-9965.epi-16-0167] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/23/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Asian Americans (AA) are the fastest growing U.S. population, and when properly distinguished by their ethnic origins, exhibit substantial heterogeneity in socioeconomic status, health behaviors, and health outcomes. Cancer is the second leading cause of death in the United States, yet trends and current patterns in the mortality burden of cancer among AA ethnic groups have not been documented. METHODS We report age-adjusted rates, standardized mortality ratios, and modeled trends in cancer-related mortality in the following AA ethnicities: Asian Indians, Chinese, Filipinos, Japanese, Koreans, and Vietnamese, from 2003 to 2011, with non-Hispanic whites (NHW) as the reference population. RESULTS For most cancer sites, AAs had lower cancer mortality than NHWs; however, mortality patterns were heterogeneous across AA ethnicities. Stomach and liver cancer mortality was very high, particularly among Chinese, Koreans, and Vietnamese, for whom these two cancer types combined accounted for 15% to 25% of cancer deaths, but less than 5% of cancer deaths in NHWs. In AA women, lung cancer was a leading cause of death, but (unlike males and NHW females) rates did not decline over the study period. CONCLUSIONS Ethnicity-specific analyses are critical to understanding the national burden of cancer among the heterogeneous AA population. IMPACT Our findings highlight the need for disaggregated reporting of cancer statistics in AAs and warrant consideration of tailored screening programs for liver and gastric cancers. Cancer Epidemiol Biomarkers Prev; 25(10); 1371-82. ©2016 AACR.
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Affiliation(s)
- Caroline A Thompson
- Graduate School of Public Health, San Diego State University, San Diego, California. Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California. Stanford Comprehensive Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Katherine G Hastings
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
| | - Kristopher Kapphahn
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Peter Yu
- Palo Alto Foundation Medical Group, Palo Alto Medical Foundation, Palo Alto, California
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California. Stanford Comprehensive Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Ami S Bhatt
- Department of Medicine and Department of Genetics, Stanford University, Stanford, California. Center for Innovation in Global Health, Stanford University, Stanford, California
| | - Heather A Wakelee
- Stanford Comprehensive Cancer Institute, Stanford University School of Medicine, Stanford, California. Division of Oncology, Stanford University School of Medicine, Stanford, California
| | - Manali I Patel
- Division of Oncology, Stanford University School of Medicine, Stanford, California. VA Palo Alto Health Care System, Palo Alto, California
| | - Mark R Cullen
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California. Stanford Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California
| | - Latha P Palaniappan
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California.
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Survival among Never-Smokers with Lung Cancer in the Cancer Care Outcomes Research and Surveillance Study. Ann Am Thorac Soc 2016; 13:58-66. [PMID: 26730864 DOI: 10.1513/annalsats.201504-241oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE Differences in patient characteristics and outcomes have been observed among current, former, and never-smokers with lung cancer, but most prior studies included few never-smokers and were not prospective. OBJECTIVES We used data from a large, prospective study of lung cancer care and outcomes in the United States to compare characteristics of never-smokers and smokers with lung cancer and to examine survival among the never-smokers. METHODS Smoking status at diagnosis was determined by self-report and survival was determined from medical records and cancer registries, with follow-up through June 2010 or later. Cox regression was used to examine the association between smoking and survival, and to identify predictors of survival among never-smokers. MEASUREMENTS AND MAIN RESULTS Among 3,410 patients with lung cancer diagnosed between September 1, 2003 and October 14, 2005 who completed a baseline patient survey, there were 274 never-smokers (8%), 1,612 former smokers (47%), 1,496 current smokers or smokers who quit recently (44%), and 28 with missing information about smoking status (<1%). Never-smokers appeared more likely than former and current/recent smokers to be female and of Asian or Hispanic race/ethnicity, and to have adenocarcinoma histology, fewer comorbidities, private insurance, and higher income and education. Compared with never-smokers, the adjusted hazard of death from any cause was 29% higher among former smokers (hazard ratio, 1.29; 95% confidence interval, 1.08-1.55), and 39% higher among current/recent smokers (hazard ratio, 1.39; 95% confidence interval, 1.16-1.67). Factors predicting worse overall survival among never-smokers included Hispanic ethnicity, severe comorbidity, undifferentiated histology, and regional or distant stage. Never-smoking Hispanics appeared more likely to have regional or advanced disease at diagnosis and less likely to undergo surgical resection, although these differences were not statistically significant. CONCLUSIONS Never-smokers with lung cancer are more likely than ever-smokers to be female, Asian or Hispanic, and more advantaged socioeconomically, suggesting possible etiologic differences in lung cancer by smoking status. Among never-smokers, Hispanics with lung cancer had worse survival than non-Hispanic whites.
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Li D, Du XL, Ren Y, Liu P, Li S, Yang J, Lv M, Chen L, Wang X, Li E, Yang J, Yi M. Comparative Analysis of Clinicopathologic Features of, Treatment in, and Survival of Americans with Lung or Bronchial Cancer. PLoS One 2016; 11:e0156617. [PMID: 27244238 PMCID: PMC4886968 DOI: 10.1371/journal.pone.0156617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/17/2016] [Indexed: 01/12/2023] Open
Abstract
Ethnic disparities in lung and bronchial cancer diagnoses and disease-specific survival (DSS) rates in the United States are well known. However, few studies have specifically assessed these differences in Asian subgroups. The primary objectives of the retrospective analysis described herein were to identify any significant differences in clinicopathologic features, treatment, and survival rate between Asian lung cancer patients and lung cancer patients in other broad ethnic groups in the United States and to determine the reasons for these differences among subgroups of Asian patients with lung or bronchial cancer. We searched the Surveillance, Epidemiology, and End Results Program database to identify patients diagnosed with lung or bronchial cancer from 1990 to 2012. Differences in clinicopathologic features, treatment, and DSS rate in four broad ethnic groups and eight Asian subgroups were compared. The study population consisted of 849,088 patients, 5.2% of whom were of Asian descent. Female Asian patients had the lowest lung and bronchial cancer incidence rates, whereas male black patients had the highest rates. Asian patients had the best 5-year DSS rate. In our Asian subgroup analysis, Indian/Pakistani patients had the best 5-year DSS rate, whereas Hawaiian/Pacific Islander patients had the worst 5-year DSS rates. We found the differences in DSS rate among the four broad ethnic groups and eight Asian subgroups when we grouped patients by age and disease stage, as well. Asian patients had better DSS rates than those in the other three broad ethnic groups in almost every age and disease-stage group, especially in older patients and those with advanced-stage disease. In conclusion, we found that clinicopathologic features and treatment of lung and bronchial cancer differ by ethnicity in the United States, and the differences impact survival in each ethnic group.
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Affiliation(s)
- Dan Li
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xianglin L. Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, United States of America
| | - Yinghong Ren
- Department of Internal Medicine, Shangluo Central Hospital, Shangluo, Shaanxi, China
| | - Peijun Liu
- Department of Translational Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Shuting Li
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jiao Yang
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Meng Lv
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Ling Chen
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xin Wang
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Enxiao Li
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jin Yang
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- * E-mail: (MY); (Jin Yang)
| | - Min Yi
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail: (MY); (Jin Yang)
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Abstract
Lung cancer is predominantly associated with cigarette smoking; however, a substantial minority of patients with the disease have never smoked. In the US it is estimated there are 17,000-26,000 annual deaths from lung cancer in never smokers, which as a separate entity would be the seventh leading cause of cancer mortality. Controversy surrounds the question of whether or not the incidence of lung cancer in never-smokers is increasing, with more data to support this observation in Asia. There are several factors associated with an increased risk of developing lung cancer in never smokers including second hand smoke, indoor air pollution, occupational exposures, and genetic susceptibility among others. Adenocarcinoma is the most common histology of lung cancer in never smokers and in comparison to lung cancer in smokers appears less complex with a higher likelihood to have targetable driver mutations.
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Gomez SL, Yang J, Lin SW, McCusker M, Sandler A, Patel M, Cheng I, Wakelee HA, Clarke CA. Lung Cancer Survival Among Chinese Americans, 2000 to 2010. J Glob Oncol 2016; 2:30-38. [PMID: 28717680 PMCID: PMC5497738 DOI: 10.1200/jgo.2015.000539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite being the leading cause of cancer death, no prior studies have characterized survival patterns among Chinese Americans diagnosed with lung cancer. This study was conducted to identify factors associated with survival after lung cancer in a contemporary cohort of Chinese patients with lung cancer. METHODS The study design is a prospective descriptive analysis of population-based California Cancer Registry data. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) for overall mortality. Participants were Chinese American residents diagnosed with first primary invasive lung cancer from 2000 to 2010 (2,216 men and 1,616 women). RESULTS Among Chinese men, decreased mortality was associated with care at a National Cancer Institute cancer center (HR, 0.85; 95% CI, 0.73 to 0.99) and adenocarcinoma versus small-cell carcinoma (HR, 0.78; 95% CI, 0.65 to 0.92). Women had better survival compared with men (HR, 0.82; 95% CI, 0.75 to 0.89), with mortality associated with never married versus currently married status (HR, 1.36; 95% CI, 1.11 to 1.66), lower versus higher neighborhood socioeconomic status (HR, 1.38; 95% CI, 1.10 to 1.72 comparing lowest to highest quintile), care at a cancer center (HR, 0.80; 95% CI, 0.67 to 0.96), and squamous cell relative to small-cell carcinoma (HR, 1.60; 95% CI, 1.04 to 2.48). CONCLUSION Focusing on factors associated with marital status, community socioeconomic status, and characteristics unique to National Cancer Institute-designated cancer centers may help to identify potential strategies for improving the length of survival for Chinese Americans.
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Affiliation(s)
- Scarlett Lin Gomez
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Juan Yang
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Shih-Wen Lin
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Margaret McCusker
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Alan Sandler
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Manali Patel
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Iona Cheng
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Heather A. Wakelee
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Christina A. Clarke
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
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Patel MI, Wang A, Kapphahn K, Desai M, Chlebowski RT, Simon MS, Bird CE, Corbie-Smith G, Gomez SL, Adams-Campbell LL, Cote ML, Stefanick ML, Wakelee HA. Racial and Ethnic Variations in Lung Cancer Incidence and Mortality: Results From the Women's Health Initiative. J Clin Oncol 2015; 34:360-8. [PMID: 26700122 DOI: 10.1200/jco.2015.63.5789] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE This study aimed to evaluate racial/ethnic differences in lung cancer incidence and mortality in the Women's Health Initiative Study, a longitudinal prospective cohort evaluation of postmenopausal women recruited from 40 clinical centers. METHODS Lung cancer diagnoses were centrally adjudicated by pathology review. Baseline survey questionnaires collected sociodemographic and health information. Logistic regression models estimated incidence and mortality odds by race/ethnicity adjusted for age, education, calcium/vitamin D, body mass index, smoking (status, age at start, duration, and pack-years), alcohol, family history, oral contraceptive, hormones, physical activity, and diet. RESULTS The cohort included 129,951 women--108,487 (83%) non-Hispanic white (NHW); 10,892 (8%) non-Hispanic black (NHB); 4,882 (4%) Hispanic; 3,696 (3%) Asian/Pacific Islander (API); 534 (< 1%) American Indian/Alaskan Native; and 1,994 (1%) other. In unadjusted models, Hispanics had 66% lower odds of lung cancer compared with NHW (odds ratio [OR], 0.34; 95% CI, 0.2 to 0.5), followed by API (OR, 0.45; 95% CI, 0.27 to 0.75) and NHB (OR, 0.75; 95% CI, 0.59 to 0.95). In fully adjusted multivariable models, the decreased lung cancer risk for Hispanic compared with NHW women attenuated to the null (OR, 0.59; 95% CI, 0.35 to 0.99). In unadjusted models Hispanic and API women had decreased risk of death compared with NHW women (OR, 0.30 [95% CI, 0.15 to 0.62] and 0.34 [95% CI, 0.16 to 0.75, respectively); however, no racial/ethnic differences were found in risk of lung cancer death in fully adjusted models. CONCLUSION Differences in lung cancer incidence and mortality are associated with sociodemographic, clinical, and behavioral factors. These findings suggest modifiable exposures and behaviors may contribute to differences in incidence of and mortality by race/ethnicity for postmenopausal women. Interventions focused on these factors may reduce racial/ethnic differences in lung cancer incidence and mortality.
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Affiliation(s)
- Manali I Patel
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC.
| | - Ange Wang
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Kristopher Kapphahn
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Manisha Desai
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Rowan T Chlebowski
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Michael S Simon
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Chloe E Bird
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Giselle Corbie-Smith
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Scarlett Lin Gomez
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Lucile L Adams-Campbell
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Michele L Cote
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Marcia L Stefanick
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Heather A Wakelee
- Manali I. Patel, Ange Wang, Kristopher Kapphahn, Manisha Desai, Marcia L. Stefanick, and Heather A. Wakelee, Stanford University School of Medicine; Marcia L. Stefanick, Stanford Prevention Research Center; Heather A. Wakelee, Stanford Cancer Institute, Stanford; Rowan T. Chlebowski, Harbor-University of California, Los Angeles, Medical Center, Torrance; Chloe E. Bird, RAND Corporation, Santa Monica; Scarlett Lin Gomez, Cancer Prevention Institute of California, Fremont, CA; Michael S. Simon and Michele L. Cote, Karmanos Cancer Institute Detroit, MI; Giselle Corbie-Smith, University of North Carolina, Chapel Hill, NC; and Lucile L. Adams-Campbell, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
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Abstract
Past epidemiological observations and recent molecular studies suggest that chronic obstructive pulmonary disease (COPD) and lung cancer are closely related diseases, resulting from overlapping genetic susceptibility and exposure to aero-pollutants, primarily cigarette smoke. Statistics from the American Lung Association and American Cancer Society reveal that mortality from COPD and lung cancer are lowest in Hispanic subjects and generally highest in African American subjects, with mortality in non-Hispanic white subjects and Asian subjects in between. This observation, described as the “Hispanic paradox”, persists after adjusting for confounding variables, notably smoking exposure and sociodemographic factors. While differences in genetic predisposition might underlie this observation, differences in diet remain a possible explanation. Such a hypothesis is supported by the observation that a diet high in fruit and vegetables has been shown to confer a protective effect on both COPD and lung cancer. In this article, we hypothesise that a diet rich in legumes may explain, in part, the Hispanic paradox, given the traditionally high consumption of legumes (beans and lentils) by Hispanic subjects. Legumes are very high in fibre and have recently been shown to attenuate systemic inflammation significantly, which has previously been linked to susceptibility to COPD and lung cancer in large prospective studies. A similar protective effect could be attributed to the consumption of soy products (from soybeans) in Asian subjects, for whom a lower incidence of COPD and lung cancer has also been reported. This hypothesis requires confirmation in cohort studies and randomised control trials, where the effects of diet on outcomes can be carefully examined in a prospective study design.
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Affiliation(s)
- Robert P Young
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. School of Biological Sciences, University of Auckland, Auckland, New Zealand Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Raewyn J Hopkins
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. School of Biological Sciences, University of Auckland, Auckland, New Zealand
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Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e278S-e313S. [PMID: 23649443 DOI: 10.1378/chest.12-2359] [Citation(s) in RCA: 875] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The treatment of stage I and II non-small cell lung cancer (NSCLC) in patients with good or low surgical risk is primarily surgical resection. However, this area is undergoing many changes. With a greater prevalence of CT imaging, many lung cancers are being found that are small or constitute primarily ground-glass opacities. Treatment such as sublobar resection and nonsurgical approaches such as stereotactic body radiotherapy (SBRT) are being explored. With the advent of minimally invasive resections, the criteria to classify a patient as too ill to undergo an anatomic lung resection are being redefined. METHODS The writing panel selected topics for review based on clinical relevance to treatment of early-stage lung cancer and the amount and quality of data available for analysis and relative controversy on best approaches in stage I and II NSCLC: general surgical care vs specialist care; sublobar vs lobar surgical approaches to stage I lung cancer; video-assisted thoracic surgery vs open resection; mediastinal lymph node sampling vs lymphadenectomy at the time of surgical resection; the use of radiation therapy, with a focus on SBRT, for primary treatment of early-stage NSCLC in high-risk or medically inoperable patients as well as adjuvant radiation therapy in the sublobar and lobar resection settings; adjuvant chemotherapy for early-stage NSCLC; and the impact of ethnicity, geography, and socioeconomic status on lung cancer survival. Recommendations by the writing committee were based on an evidence-based review of the literature and in accordance with the approach described by the Guidelines Oversight Committee of the American College of Chest Physicians. RESULTS Surgical resection remains the primary and preferred approach to the treatment of stage I and II NSCLC. Lobectomy or greater resection remains the preferred approach to T1b and larger tumors. The use of sublobar resection for T1a tumors and the application of adjuvant radiation therapy in this group are being actively studied in large clinical trials. Every patient should have systematic mediastinal lymph node sampling at the time of curative intent surgical resection, and mediastinal lymphadenectomy can be performed without increased morbidity. Perioperative morbidity and mortality are reduced and long-term survival is improved when surgical resection is performed by a board-certified thoracic surgeon. The use of adjuvant chemotherapy for stage II NSCLC is recommended and has shown benefit. The use of adjuvant radiation or chemotherapy for stage I NSCLC is of unproven benefit. Primary radiation therapy remains the primary curative intent approach for patients who refuse surgical resection or are determined by a multidisciplinary team to be inoperable. There is growing evidence that SBRT provides greater local control than standard radiation therapy for high-risk and medically inoperable patients with NSCLC. The role of ablative therapies in the treatment of high-risk patients with stage I NSCLC is evolving. Radiofrequency ablation, the most studied of the ablative modalities, has been used effectively in medically inoperable patients with small (< 3 cm) peripheral NSCLC that are clinical stage I.
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Affiliation(s)
- John A Howington
- NorthShore HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, IL.
| | - Matthew G Blum
- Penrose Cardiothoracic Surgery, Memorial Hospital, University of Colorado Health, Colorado Springs, CO
| | | | - Alex A Balekian
- Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH
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Lee SSJ. Lessons Learned From the U.S. Public Health Service Syphilis Study at Tuskegee: Incorporating a Discourse on Relationships Into the Ethics of Research Participation Among Asian Americans. ETHICS & BEHAVIOR 2012. [DOI: 10.1080/10508422.2012.730002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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