Black and Asian patients were found to be at a lower risk for death from limited-stage small cell lung cancer (L-SCLC) than White patients, according to the results of a cohort study published in JAMA Network Open.1 Other factors associated with better survival included a high income (annual household median income of ≥$63,000) or education level, private insurance, female sex, diagnostic confirmation by positive cytological analysis, an increase in the number of sampled regional lymph nodes, and an earlier stage at diagnosis.

It has been established that non-small cell lung cancer outcomes are influenced by race and socioeconomic status; however, whether this trend extends to patients with SCLC is unknown.

“To our knowledge, our study is the first large-scale database study analyzing various factors associated with outcomes of L-SCLC,” the study authors wrote.

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The cohort study analyzed data from 72,409 patients from the National Cancer Database who were diagnosed with L-SCLC between 2004 and 2014. Patients were stratified into cohorts based on race/ethnicity.

In the overall population, 55.6% of patients were female, 90.4% were White, 7.9% were Black, 1.1% were Asian, 0.3% were Native American, and 0.3% were Hispanic. Nearly 70% (69.4%) of patients were on government insurance, 28.8% were on private insurance, and 1.9% had no insurance.

Most patients (74.7%) had stage III disease, followed by stage I (14.7%) and stage II (10.6%) disease. Chemotherapy was administered to 81.3% of patients, radiation therapy to 63.7%, and surgery of the primary site to 7.6%.

Compared with White patients, the risk of death from L-SCLC was found to be lowest among Asian patients (HR, 0.83; 95% CI, 0.77-0.91; P <.001) and Black patients (HR, 0.92; 95% CI, 0.89-0.95; P <.001) compared with White patients. The risk of death was similar among Native American (HR, 0.95; 95% CI, 0.82-1.13; P =.62) and Hispanic patients (HR, 1.03; 95% CI, 0.87-1.22; P =.76) as it was with White patients (HR, 1.00).

The study authors acknowledged several limitation, including the smaller number of Native American and Hispanic patients and diagnosis made before recent and substantial improvements in treatment.

They concluded, “the findings of this cohort study suggest that race is associated with survival of L-SCLC,” adding, “given the complex interaction among several factors, more studies are warranted to formulate strategies to overcome the disparities that we have highlighted.”

Disclosures: Some of the study authors disclosed financial relationships with the pharmaceutical industry and/or the medical device industry. For a full list of disclosures, please refer to the original study.


Zhou K, Shi H, Chen R, et al. Association of race, socioeconomic factors, and treatment characteristics with overall survival in patients with limited-stage small cell lung cancer. JAMA Netw Open. 2021;4(1):e2032276. doi:10.1001/jamanetworkopen.2020.32276