Disparities in surgical resection of early-stage non-small cell lung cancer

OBJECTIVES: The aim of our study was to identify the factors that determined whether a patient underwent surgery and its impact on patient outcome. METHODS: A retrospective evaluation of the records of all patients diagnosed with resectable stages I and II non-small cell lung cancer between 1990 and 1998 at the University of Arkansas and Veterans Administration Hospitals were included in the study. Demographic, clinical, pathologic, and outcome data were captured. Analysis was conducted to identify prognostic factors as well as factors leading to surgical treatment disparities. RESULTS: A total of 551 patients were included; 490 (89%) were men, 480 (87%) were white, and 315 (57%) were aged >65 years. Median follow-up of these patients was 24 months (1-109 months). Surgery was performed on 455 patients (82.6%); 26 patients received nonsurgical treatment including chemotherapy, radiation therapy, or both, and 70 patients did not receive any type of treatment. A univariate analysis revealed that age, race, sex, and forced expiratory volume in the first second were significantly different between the surgery and no surgery groups. However, a multivariate analysis showed that age, forced expiratory volume in 1 second, and hemoglobin were significantly different between both groups. The median overall survival was 45.5 months (1-109 months) for the surgically treated patients compared with 12.0 months (1-86 months) for those who did not undergo surgery (P <.0001). CONCLUSION: Elderly patients with early-stage non-small cell lung cancer are less likely to undergo a potentially curative surgical resection. Racial and sex disparities may be due to other comorbidities.