Asian ethnicity is a favorable prognostic factor for overall survival in non-small cell lung cancer (NSCLC) and is independent of smoking status

J Thorac Oncol. 2009 Sep;4(9):1083-93. doi: 10.1097/JTO.0b013e3181b27b15.

Abstract

Background: We previously showed that Asian ethnicity was an independent favorable prognostic factor in non-small cell lung cancer (NSCLC). Many Asian NSCLC patients were never-smokers, and never-smokers had improved survival than ever-smokers. We investigated whether Asian ethnicity is a favorable prognostic factor independent of smoking status.

Methods: Retrospective population-based study of NSCLC cases from the cancer surveillance programs of three Southern California counties from 1991 to 2005.

Results: A total of 20,140 NSCLC patients with known smoking status were analyzed of which 9.1% were never-smokers and 6.5% were Asians. There was a threefold increase in the percentage of Asian never-smokers as compared with ever-smokers. Asians had the highest overall survival (OS) among the 4 major ethnicities (p < 0.0001) and never-smokers had improved OS over ever-smokers (p = 0.0183) by univariate analyses. By multivariate analyses, Asian ethnicity was an independent and favorable prognostic factor for OS (versus non-Asian; hazard ratio [HR] = 0.861, 95% confidence interval [CI]: 0.808-0.918, p < 0.0001), among smokers (versus non-Asian; HR = 0.867, 95% CI: 0.807-0.931, p < 0.0001), and among never-smokers (versus non-Asian; HR = 0.841, 95% CI: 0.728-0.971, p = 0.0180). Never-smoker was a favorable prognostic factor if ethnicity was not accounted for (versus ever-smoker; HR = 0.936, 95% CI: 0.886-0.988, p = 0.0169) but was no longer an independent favorable prognostic factor (versus ever-smoker; HR = 0.953, 95% CI: 0.902-1.007, p = 0.0861) after accounting for ethnicity.

Conclusions: Asian ethnicity is an independent favorable prognostic factor for OS in NSCLC regardless of smoking status.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Asian People*
  • Carcinoma, Non-Small-Cell Lung / ethnology*
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Carcinoma, Non-Small-Cell Lung / therapy
  • Female
  • Humans
  • Lung Neoplasms / ethnology*
  • Lung Neoplasms / mortality
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies
  • Smoking / adverse effects*
  • Socioeconomic Factors