Survival outcomes in non-small cell lung cancer: Real-world analysis of immunotherapy era vs pre-immunotherapy era, with insights into treatment settings, racial disparities, and socioeconomic impacts.

Abstract

e20597 Background: Immunotherapy has transformed non-small cell lung cancer (NSCLC) outcomes, with pivotal trials like IMpower010, PACIFIC, and KEYNOTE 189 showcasing its efficacy. Using data from the National Cancer Data Base, this study evaluates survival trends in the immunotherapy era (IE) versus the pre-immunotherapy era (PIE) focusing on geographic, socioeconomic, and racial disparities. Methods: Survival probabilities were analyzed with Kaplan-Meier plots, and log-rank tests compared outcomes between IE (2016–2021) and PIE (2010–2015). Median OS, 5-year OS, and Cox regression hazard ratios (HR) assessed demographic, clinical, and socioeconomic impacts on NSCLC survival (p < 0.05). Results: Data from 1,516,865 NSCLC patients showed significant survival improvements across all stages in the immunotherapy era (p < 0.001). Survival was higher for patients treated at academic centers (p < 0.001). However, racial disparities persisted, with Asian and Hispanic patients having better outcomes than non-Hispanic Black and White patients. Cox regression revealed immunotherapy reduced mortality (HR = 0.59, p < 0.001). Advanced stages, particularly Stage IV (HR = 7.06, p < 0.001), were linked to higher mortality. Protective factors included female sex (HR = 0.75), younger age, and academic center care (HR = 0.84; p < 0.001). Uninsured (HR = 1.33) and Medicaid patients (HR = 1.55) had worse outcomes, higher income and education levels improved survival. The table below presents the median survival for all the variables. Conclusions: Immunotherapy has significantly improved NSCLC survival at all stages. Better outcomes were seen with academic center care, private insurance, and higher socioeconomic status, highlighting the need for equitable access. Racial disparities persist, requiring targeted interventions, and advanced-stage patients continue to face poor outcomes, stressing the need for early detection. These findings emphasize reducing socioeconomic and racial disparities and expanding therapy access to improve survival for all NSCLC patients. Category Group N Median Survival (Months) 5 yr OS (%) P Value All Stages IE 789,519 26.78 34 <0.001 PIE 727,346 16.23 26 Stage I & II IE 312,268 74.28 57 <0.001 PIE 265,231 61.77 51 Stage III IE 139,407 23.72 29 <0.001 PIE 141,636 16.36 21 Stage IV IE 288,684 6.97 12 <0.001 PIE 290,829 5.49 6 Facility Academic 257,241 35.42 39 <0.001 Non-Academic 527,626 23.10 31 Race Hispanic 27,697 33.41 39 <0.001 Asian 27574 40.18 41 Non-Hispanic - Black 86,457 22.70 32 Non-Hispanic - White 627,467 26.64 34 Insurance Private 176,117 40.51 43 <0.001 Medicaid 58,706 21.95 32 Medicare 512663 24.61 31 Not Insured 15,160 11.10 25 Median Income < $46,277 126,800 20.86 29 <0.001 $46,277-$57,856 158,217 23.43 31 $57,857 - $74,062 161,045 27.04 34 $74,063 + 216,177 34.23 39