Introduction: Blacks are more likely than whites to refuse potentially curative surgery for early stage non-small\r\ncell lung cancer (NSCLC). We sought to compare survival among blacks and whites in this population, as patients who\r\nrefuse the surgery are expected to be different from others. Also, racial differences are known to exist in the end-of-life\r\ncare preferences.\r\nMethods: Surveillance, Epidemiology, and End Results (SEER) database was used to create a cohort of 970\r\npatients diagnosed with stage I and II NSCLC between 1988 and 2002 who refused surgery. The outcome was\r\noverall and lung cancer-specific survival, while race was the key predictor variable. Kaplan-Meier survival analysis\r\nwas performed to estimate crude survival differences. Potential confounders were adjusted for in Cox-proportional\r\nregression analysis.\r\nResults: A majority (78%) was white and 11% were blacks. In the crude analysis of all-cause mortality, blacks\r\ntended to have lower mortality than whites (p-value 0.075). In the adjusted model, blacks had 19% lower risk of\r\nmortality than whites (HR 0.81, 95% C.I. 0.67, 0.99, p-value 0.045). There were no differences in cancer-specific\r\nmortality in either crude or adjusted analysis. Females, individuals who receive radiotherapy and those with higher\r\neducation in a county had lower risk of overall and cancer-specific mortality.\r\nConclusions: Among patients who refused surgery for early stage NSCLC, blacks have a lower risk of all-cause\r\nmortality than whites, but there are no differences in the cancer-specific mortality. This should be interpreted with\r\ncaution due to lack of chemotherapy data and information on quality of life.
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