Racial disparities in non–small cell lung cancer survival outcomes: a systematic review and meta-analysis

Abstract

Background: Previous studies have demonstrated disparities in survival outcomes between Black/African American, Asian, and White patients with non–small cell lung cancer (NSCLC). Some studies have suggested that non-White patients have poorer survival outcomes due to socioeconomic factors, while others have reported different findings. Therefore, we performed a comprehensive review and meta-analysis to evaluate the impact of racial disparity on NSCLC survival outcomes. Method: PubMed, Ovid MEDLINE, Embase, and Google Scholar were searched for articles published until September 2024. Eligible studies with aligned research objectives were included. Two reviewers independently extracted data. Methodological quality was assessed using the Newcastle-Ottawa Scale. The meta-analysis adhered to the PRISMA guidelines. Result: Fifteen studies with 763,314 patients met the eligibility criteria. Asian and Asian/Pacific Islander (API) patients had significantly better overall survival (OS) compared to White patients (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.79–0.94; P < 0.01 and HR, 0.80; 95% CI, 0.69–0.93; P < 0.01, respectively). In contrast, OS differences were not statistically significant between Black and White (HR, 1.00; 95% CI, 0.94–1.07; P < 0.01) or Hispanic and White patients (HR, 0.93; 95% CI, 0.87–1.00; P = 0.19). Further, the subgroup analyses did not demonstrate any significant difference in OS outcome in any stage when comparing Black to White patients (stage I HR, 1.11; 95% CI, 1.00–1.23; P < 0.01; stage II HR, 1.03; 95% CI, 0.96–1.10; P = 0.26; stage III HR, 1.04; 95% CI, 0.96–1.12; P < 0.01; and stage IV HR, 1.02; 95% CI, 0.97–1.07; P < 0.01). Conclusion: Asian and API patients with NSCLC exhibited superior OS outcomes compared to White patients. In contrast, racial disparities in survival outcomes were statistically insignificant for Black and Hispanic patients. Additionally, staging disparities in OS were not observed between Black and White patients with NSCLC.