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Survival Analysis of Postoperative Adjuvant Chemotherapy for Stage IB Non-Small Cell Lung Cancer Based on Racial
Shaowei Xin1,2, Tao Wang2, Xiaodi Qi1
1Department of Thoracic Surgery, 962 Hospital of the Joint Logistics Support Force, Harbin, Heilongjiang, China.
Background:
The survival benefits of adjuvant chemotherapy for stage IB non-small cell lung cancer (NSCLC) remain controversial. The existing evidence is mostly based on the Caucasian population, especially the differences in efficacy among different races are not yet clear.
Method:
Based on the data of patients with stage T2N0M0 NSCLC in the SEER database from 2010 to 2018 (n = 7458), they were divided into white people (6076 cases) and non-white people (1382 cases). The baseline characteristics of the adjuvant chemotherapy group and the non-adjuvant chemotherapy group were balanced by propensity score matching (PSM). The overall survival (OS) was assessed using Kaplan-Meier methodology with log-rank testing, while multivariable Cox regression analysis was employed to identify independent prognostic factors.
Result:
Among white people, the OS of the adjuvant chemotherapy group was significantly better than that of the observation group (p < 0.001 before and after PSM), and the benefits were consistent regardless of tumor diameter (≤ 4 or > 4 cm), VPI, or grade of differentiation. There was no statistically significant difference in OS among non-white people (p > 0.05 before and after PSM), and only the poorly differentiated subgroup showed limited benefits (p = 0.008). Multivariate Cox analysis confirmed that adjuvant chemotherapy was an independent predictor of OS in white people (p < 0.001), but not associated with non-white people (p = 0.184).
Conclusion:
There are significant racial differences in the efficacy of adjuvant chemotherapy for stage IB NSCLC, suggesting that treatment decisions need to be optimized in combination with racial background.
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