Electronic Theses and Dissertations
Predicting Postoperative Mortality and Evaluating Racial Disparities in Surgical Quality and Survival in Non-Small Cell Lung Cancer.
Date of Award
Doctor of Philosophy
Lung cancer is the leading cause of cancer-related death in the US. The majority of early stage lung cancer patients are treated with curative-intent surgical resection; however, patients who undergo resection still exhibit poor outcomes, indicating inequitable cancer care. Across three epidemiologic studies related to the surgical treatment of lung cancer, we examined resections from 2009-2019 in the Mid-South region of the US. First, we identified risk factors known preoperatively for 120-day postoperative mortality and constructed a nomogram to predict the probability of 120-day mortality for individual patients. Preoperative risk factors associated with 120-day mortality included age, tumor size, tumor grade, ASA score, Charlson index, neoadjuvant therapy, and extent of resection. Our nomogram demonstrated modest discrimination (optimism-adjusted area under the curve of 0.706). Decision curve analysis illustrated that the nomogram was clinically useful across a range of risk thresholds.Next, we evaluated overall 5-year survival (OS) after curative-intent surgical resection between black and white lung cancer patients. Unadjusted survival estimates showed no difference in 5-year OS between the races. There was significant effect modification by insurance after adjusting for confounders. Among patients on Medicaid, white patients had a significantly higher hazard of death than black patients (HR 1.41; 95% CI: 1.10, 1.79); however, among patients with commercial insurance, whites had a lower hazard of death than blacks (HR 0.89; 95% CI: 0.73, 1.09). Finally, we assessed the quality of surgery between black and white stage I-IIIA non-small cell lung cancer patients who underwent curative-intent surgical resection using four quality metrics. We found that white patients had a significantly higher odds of receiving anatomic resection (OR 1.40; 95% CI: 1.05, 1.86), having adequate lymph node sampling (OR 1.23; 95% CI: 1.02, 1.48), and meeting the National Comprehensive Cancer Networks quality criteria (OR 1.21; 95% CI: 1.01, 1.46) than black patients; yet they had significantly lower odds of receiving a minimally invasive procedure (OR 0.83; 95% CI: 0.69, 0.99). Future research should focus on proper risk stratification of patients who are indicated for surgery and assess how location influences access to care and contributes towards racial disparities in lung cancer care outcomes.
Dissertation or thesis originally submitted to ProQuest
Taylor, Meghan, "Predicting Postoperative Mortality and Evaluating Racial Disparities in Surgical Quality and Survival in Non-Small Cell Lung Cancer." (2020). Electronic Theses and Dissertations. 2970.
Available for download on Saturday, May 25, 2024
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