• Onkar V Khullar, Theresa Gillespie, Dana C Nickleach, Yuan Liu, Kristin Higgins, Suresh Ramalingam, Joseph Lipscomb, and Felix G Fernandez.
• Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA.
• J. Am. Coll. Surg.. 2015 Feb 1;220(2):156-168.e4.

BackgroundSeveral clinical variables, such as tumor stage and age, are well established factors associated with long-term survival after surgical resection of lung cancer. Our aim was to examine the impact of other clinical and demographic variables, controlling for known predictors of long-term survival, in order to investigate how outcomes varied according to important nonclinical factors.Study DesignThe National Cancer Data Base, jointly supported by the Commission on Cancer of the American College of Surgeons and the American Cancer Society, was used to identify patients undergoing pulmonary resection for lung cancer and perform a retrospective cohort study. The cohort consisted of patients diagnosed with nonsmall cell lung cancer from 2003 to 2006, who underwent resection; overall survival data are available only for patients diagnosed through 2006. A Cox proportional hazards survival model was used to examine factors associated with risk of mortality.ResultsA total of 92,929 patients were identified as diagnosed during the study period and undergoing surgical resection for lung cancer. On multivariable analysis, several socioeconomic factors such as lack of insurance, lower income, less education, and treatment at community centers vs academic or research programs predicted worse overall survival after controlling for disease characteristics known to be predictors of worse survival, such as tumor stage, histology, age, and extent of resection.ConclusionsDiminished long-term survival after pulmonary resection was associated with a number of socioeconomic factors. To date, this represents the largest database analysis of long-term mortality in patients undergoing surgical resection for lung cancer. The disparities in survival outcomes reported here require further detailed investigation.Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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