title: Survival and Racial Differences of Non-Small Cell Lung Cancer in the United States Military.
abstract: BACKGROUND
  Lung cancer is the leading cause of cancer-related death in the United States (US) Military and worldwide, with non-small cell lung cancer (NSCLC) accounting for 87 % of cases.
  
  
  OBJECTIVE
  Using a US military cohort who receives equal and open access to healthcare, we sought to examine demographic, clinical features and outcomes with NSCLC.
  
  
  METHODS
  We conducted a retrospective cohort analysis of 4,751 patients, aged ≥ 18 years and diagnosed with a first primary NSCLC between 1 January 2003 and 31 December 2013 in the US Department of Defense (DoD) cancer registry.
  
  
  METHODS
  Differences by patient and disease characteristics were compared using Chi-square and t-test. Kaplan Meier curves and Cox proportional hazards regression assessed overall survival.
  
  
  RESULTS
  The mean age at diagnosis was 66 years, 64 % were male, 72 % were Caucasian, 41 % were diagnosed at early stage, 77 % received treatment and 82 % had a history of tobacco use. Mean age at diagnosis was highest among Caucasians (67 years) and lowest among African Americans (AA; 62 years). Asian/Pacific Islanders (PI) were more likely to be female (p < 0.0001), have adenocarcinoma histology (p = 0.0003) and less likely to have a history of tobacco use (p < 0.0001) compared to other racial/ethnic groups. In multivariable survival analysis, older age, male gender, increasing stage, not receiving treatment, and tobacco history were associated with higher mortality risk. Untreated patients exhibited a 39 % higher mortality risk compared to treated patients (HR = 1.39; 95%CI = 1.23-1.57). Compared to Caucasian patients, Asian/PIs demonstrated a 20 % lower risk of death (HR = 0.80; 95%CI = 0.66-0.96). There was no difference in mortality risk between AAs and Hispanics compared to Caucasians.
  
  
  CONCLUSIONS
  The lack of significant outcome disparity between AAs and Caucasians and the earlier stage at diagnosis than usually seen in civilian populations suggest that equal access to healthcare may play a role in early detection and survival.
authors: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889-5600, USA.
authors: Christina
authors: C
authors: Brzezniak
authors: Q.D. Research, Inc, 8777 Auburn Folsom Road Suite C501, Granite Bay, 95746, CA, USA.
authors: Sacha
authors: S
authors: Satram-Hoang
authors: Genentech, Inc, 1 DNA Way, South San Francisco, 94080, CA, USA.
authors: Hans-Peter
authors: HP
authors: Goertz
authors: Genentech, Inc, 1 DNA Way, South San Francisco, 94080, CA, USA.
authors: Carolina
authors: C
authors: Reyes
authors: Q.D. Research, Inc, 8777 Auburn Folsom Road Suite C501, Granite Bay, 95746, CA, USA.
authors: Ashok
authors: A
authors: Gunuganti
authors: Washington Cancer Institute, MedStar Washington Hospital Center, 110 Irving St NW C2149, Washington, 20010, DC, USA.
authors: Christopher
authors: C
authors: Gallagher
authors: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20889-5600, USA. corey.a.carter.mil@mail.mil.
authors: Corey A
authors: CA
authors: Carter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D044469:Racial Groups / Q000208:ethnology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: lung cancer; military; survival outcomes