title: Racial and Ethnic Differences in Lung Cancer Surgical Stage: An STS Database Study.
abstract: BACKGROUND
  Racial and ethnic differences in lung cancer care have been previously documented. These differences may be related to access to care, cultural differences, or fewer patients presenting with operable lung cancer. The relationship between race and pathologic stage of patients who undergo lung cancer resection has not been defined. This study estimates racial disparities in lung cancer stage among patients who undergo surgical resection.
  
  
  METHODS
  The Society of Thoracic Surgeons (STS) database was queried for patients who underwent resection of non-small cell lung cancer and had complete pathologic staging and racial identification. Univariate and multivariate analyses were performed. Study end point was the pathologic stage and we evaluated its association with the racial and ethnic origins of the patients.
  
  
  RESULTS
  Of 19,173 eligible patients with non-small cell lung cancer of known pathological stage who underwent surgery between 2002 and 2008, the majority were Caucasian (17,148, 89.4%), 1,502 (7.8%) were African-American, 273 (1.4%) were Asian, and 250 (1.3%) were Hispanic. In univariate analysis, significantly more Caucasian and African-American patients underwent resection of stage I/II lung cancer (13,929, 81.2% and 1,217, 81%, respectively) as compared with the Asian (207, 75.2%) and Hispanic (188, 75.8%) patients (p = 0.007). Stage at operation did not differ between Caucasians and African-Americans. Multivariate analysis confirmed these findings (p = 0.03) after adjustment for age, gender, tobacco use, diabetes, and year of surgery.
  
  
  CONCLUSIONS
  Within the STS database, patients identified as Asian or Hispanic had a significantly higher pathologic stage at the time of resection than Caucasian or African-American patients. The causes of these differences in the treatment of potentially curable lung cancer are unknown and require further investigation.
authors.affiliation: Division of Thoracic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.
authors.forename: Benny
authors.initials: B
authors.lastname: Weksler
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, United States.
authors.forename: Andrzej S
authors.initials: AS
authors.lastname: Kosinski
authors.affiliation: Division of Thoracic Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States.
authors.forename: William R
authors.initials: WR
authors.lastname: Burfeind
authors.affiliation: Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, United States.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Silvestry
authors.affiliation: Division of Thoracic Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sullivan
authors.affiliation: Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina, United States.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D002289:Carcinoma, Non-Small-Cell Lung / Q000208:ethnology* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000208:ethnology* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*