Racial disparities in non–small cell lung cancer survival outcomes: a systematic review and meta-analysis

Abstract

Background

Previous studies have demonstrated disparities in survival outcomes between Black/African American, Asian, and White patients with non–small cell lung cancer (NSCLC). Some studies have suggested that non-White patients have poorer survival outcomes due to socioeconomic factors, while others have reported different findings. Therefore, we performed a comprehensive review and meta-analysis to evaluate the impact of racial disparity on NSCLC survival outcomes.

Method

PubMed, Ovid MEDLINE, Embase, and Google Scholar were searched for articles published until September 2024. Eligible studies with aligned research objectives were included. Two reviewers independently extracted data. Methodological quality was assessed using the Newcastle-Ottawa Scale. The meta-analysis adhered to the PRISMA guidelines.

Result

Fifteen studies with 763,314 patients met the eligibility criteria. Asian and Asian/Pacific Islander (API) patients had significantly better overall survival (OS) compared to White patients (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.79–0.94; P < 0.01 and HR, 0.80; 95% CI, 0.69–0.93; P < 0.01, respectively). In contrast, OS differences were not statistically significant between Black and White (HR, 1.00; 95% CI, 0.94–1.07; P < 0.01) or Hispanic and White patients (HR, 0.93; 95% CI, 0.87–1.00; P = 0.19). Further, the subgroup analyses did not demonstrate any significant difference in OS outcome in any stage when comparing Black to White patients (stage I HR, 1.11; 95% CI, 1.00–1.23; P < 0.01; stage II HR, 1.03; 95% CI, 0.96–1.10; P = 0.26; stage III HR, 1.04; 95% CI, 0.96–1.12; P < 0.01; and stage IV HR, 1.02; 95% CI, 0.97–1.07; P < 0.01).

Conclusion

Asian and API patients with NSCLC exhibited superior OS outcomes compared to White patients. In contrast, racial disparities in survival outcomes were statistically insignificant for Black and Hispanic patients. Additionally, staging disparities in OS were not observed between Black and White patients with NSCLC.

Lung cancer remains the leading cause of cancer-related mortality in the United States, with 127,070 deaths reported and 238,340 new cases diagnosed in 2023.¹ Among lung cancer subtypes, non–small cell lung cancer (NSCLC) accounts for approximately 85% of cases, including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.² NSCLC is one of the most common and lethal forms of cancer globally, with survival outcomes heavily influenced by factors such as stage at diagnosis, access to treatment, and socioeconomic status. In addition to these clinical and systemic determinants, racial and ethnic disparities in NSCLC survival outcomes have been extensively documented. Variations in survival rates among Black/African American, Asian, Hispanic, and White patients underscore significant inequities in cancer care.³ These disparities are often attributed to health care access, socioeconomic factors, and treatment patterns.⁴ Previous studies have reported conflicting findings on the extent and nature of these disparities. While some research has highlighted poorer survival outcomes among non-White patients, particularly Black individuals, due to inequities in health care access and socioeconomic conditions,⁵ others have suggested that survival differences may also stem from variations in treatment approaches or potential biological differences across racial and ethnic groups.⁶

The prognosis of NSCLC is often poor, mainly due to late-stage diagnoses when curative treatment options are limited. Standard treatments, including surgery, chemotherapy, targeted therapies, and immunotherapy, are typically stage-dependent. For early-stage NSCLC, surgery remains the cornerstone of therapy, while advanced-stage cases often require multimodal approaches combining chemotherapy, radiation, and emerging immunotherapies.⁷ However, racial disparities persist across all stages of NSCLC, affecting both access to and outcomes of these treatments.

For early-stage NSCLC, disparities in the likelihood of undergoing potentially curative surgical interventions are evident. Studies have shown that Black patients are significantly less likely to receive surgery for early-stage NSCLC compared to White patients, even when it is clinically indicated.⁸ Such disparities may result from socioeconomic barriers, health care access inequities, and implicit biases within the health care system. These treatment gaps can lead to worsened survival outcomes among minority groups.

In advanced stages, where multimodal therapies such as immunotherapy and radiation are often employed, racial disparities continue to affect survival outcomes. For example, the uptake of immunotherapy—one of the most promising advancements in NSCLC treatment—has been disproportionately lower among minority populations, including Black and Hispanic patients, compared to White patients.⁹ These differences may result from underrepresentation in clinical trials, lack of access to cutting-edge therapies, and financial or systemic barriers. Additionally, the survival benefit of immunotherapy may vary by race, potentially influenced by differences in tumor biology or immune response mechanisms. Despite advancements in treatment modalities, survival outcomes in NSCLC remain significantly influenced by clinical, biological, and sociodemographic factors. The documented disparities in treatment access, uptake, and outcomes highlight a pressing need to address inequities across all stages of the disease.

This systematic review and meta-analysis aims to synthesize evidence on racial disparities in NSCLC survival outcomes, focusing on overall survival (OS) across racial and ethnic groups. The analysis evaluates disparities across all stages of NSCLC, from early-stage disease, where curative surgical options may be underutilized, to advanced-stage cases requiring multimodal approaches, including chemotherapy, radiation, and immunotherapy. By consolidating data from diverse studies, this review seeks to uncover how disparities in diagnosis, treatment access, and outcomes manifest at different stages of the disease.

METHODS

The current systematic review and meta-analysis was conducted per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)¹⁰ guideline.

Three investigators (CW, NK, VP) independently searched for published articles indexed in PubMed, Embase, Ovid MEDLINE, and Google Scholar. The electronic search was conducted separately, utilizing keywords to search for all articles published before September 15, 2024. The keywords, which included terms related to NSCLC and racial disparity, were combined using the Boolean values “AND” and “OR.” The complete list of search terms used in the systematic search is presented in the Supplemental Material. After the eligible articles were identified, a manual search from the lists of references of the selected studies was further performed to ensure that all relevant articles were included in the analysis.

The reviewers utilized predetermined eligibility criteria to include studies in the analysis. Articles were included if they met the following criteria: (1) published in the English language, to ensure that the original meaning of the data collected was not lost during translation; (2) studies of patients with NSCLC; (3) studies reporting differences in survival outcomes according to race/ethnic background; and (4) studies including a total sample size of more than 50 patients, to enhance the statistical power of our meta-analysis. Similarly, studies were excluded from the analysis if they met the following exclusion criteria: (1) not published in the English language; (2) lack of inclusion of patients with NSCLC; and (3) lack of investigation of the racial disparities in patients with NSCLC.

Three independent reviewers reviewed all articles selected according to the inclusion criteria. They then collected all the relevant data from the articles: author (first author’s last name and year of publication of the article), the study design, the characteristics of participants (sample size, age, gender distributions, racial distribution), median follow-up period, OS of the patients, and primary outcomes.

The Newcastle-Ottawa Scale was utilized to assess the methodological quality of the included studies. This scale assesses the quality of the studies using three domains: comparability, participant selection, and outcomes reporting. The Supplemental Material presents the quality of each study.

All statistical analyses were performed using R version 4.3.2 (Vienna, Austria) and meta package version 7.0–0. The hazard ratio (HR) and its associated 95% confidence interval (CI) from each study were obtained and combined using the generic inverse variance method per DerSimonian and Laird.¹¹ The random effects model was applied due to the different study designs and patient populations of the included studies. Study heterogeneity was evaluated using Cochran’s Q test and the I² statistic, with an I² value of greater than 75% being high heterogeneity; 50% to 75%, moderate heterogeneity; and less than 50%, low heterogeneity. The presence of publication bias was assessed by directly visualizing the funnel plots. If publication bias was present, the trim-and-fill method adjusted the summary effects.

RESULTS

The electronic search yielded 3589 articles from all the databases. The articles were analyzed, automation tools were identified, and duplicates were removed. The abstracts of the remaining 3351 articles were then screened, and only 80 studies met the screening criteria. The articles that met the screening criteria were retrieved and assessed using the predetermined eligibility criteria. After careful assessment, only 15 studies met the inclusion criteria and were included in the study. The other studies were excluded: 40 did not have patients with NSCLC, 23 did not assess racial disparities in the outcomes, and two did not report 95% CI. A PRISMA diagram to summarize the search strategy is presented in Figure 1.

Figure 1.

PRISMA diagram summary for the literature search.

Characteristics of the included studies

The 15 studies included in the meta-analysis were retrospective cohort studies conducted between 2009 and 2024.^12–27 Patients were mainly from the United States (n = 13), United Kingdom (n = 1), and China (n = 1). The baseline characteristics of each study are shown in Table 1. In the included studies, the total sample size of the review was 763,314 patients, of whom 617,497 (80.9%) were White, 85,951 (11.3%) were Black, 19,108 (2.5%) were Asian/Pacific Islander (API), 8491 (1.1%) were Hispanic, 1100 (0.1%) were Asian, and 31,841 (4.1%) were other. The mean age of the patients ranged from 64.4 to 70 years. The gender distribution was about 59.8% male and 40.2% female.

Table 1.

Baseline characteristics of all studies included in the meta-analysis

Author	Study design	Country of origin	Database	Total patients (N)	Characteristics			Overall survival (HR and 95% CI)
					Mean age (y)	Sex M: F	Racial distribution
Yang et al, 201012	Retrospective cohort	USA	Florida Cancer Data System	76,086	69.6	42,266: 33,820	W: 70,653 B/AA: 5106 Other: 456	B/AA vs W: 0.97 (0.94–1.01)
Saeed et al, 201213	Retrospective cohort	USA	SEER Database	172,398	67	100,070: 72,328	W: 136,366 B/AA: 17,756 Other: 18,791	B/AA vs W: 1.09 (1.07–1.11)
Zheng et al, 201214	Retrospective cohort	USA	Department of Defense Automated Central Tumor Registry	8347	N/A	7444: 903	W: 7444 B/AA: 903	B/AA vs W: 1.03 (0.91–1.17)
Elchoufani et al, 201315	Retrospective cohort	USA	Vidant Medical Center Cancer Registry	2351	67	1472: 879	W: 1,634 B/AA: 717	B/AA vs W: 0.94 (0.84–1.05)
Nimako et al, 201316	Retrospective cohort	UK	Lung Unit Research Database	423	64.4	276: 147	W: 266 B/AA:64 A: 72 Other: 21	B/AA vs W: 0.8 (0.6–1.0) A vs W: 0.6 (0.3–1.0)
Ganti et al, 201417	Retrospective cohort	USA	Veterans Affairs Central Cancer Registry	82,414	68.5	81,118: 1296	W: 67,032 B/AA: 14,791 A: 300 Other: 291	B/AA vs W 0.94 (0.92–0.96) A vs W: 0.96 (0.84–1.09)
Hua et al, 201418	Retrospective cohort	USA	Georgia Cancer Registry	934	N/A	605: 329	W: 675 B/AA: 259	B/AA vs W: 0.93 (0.79–1.11)
Tannenbaum et al, 201419	Retrospective cohort	USA	Florida Cancer Data System Registry	98,541	70	55,203: 43,338	W: 90,534 B/AA: 7249 A: 472 Other: 286	B/AA vs W: 0.99 (0.96–1.02) A vs W: 0.85 (0.76–0.95)
Brzezniak et al, 201520	Retrospective cohort	USA	Department of Defense Automated Central Tumor Registry	4751	66	3054: 1697	W: 3434 B/AA: 533 API: 468 H: 112 Other: 204	B/AA vs W: 0.90 (0.77–1.07) API vs W: 0.80 (0.66–0.96) H vs W: 1.16 (0.83–1.63)
Minocha et al, 201721	Retrospective cohort	USA	University of Florida Hospital Database	1301	N/A	N/A	W: 856 B/AA: 445	B/AA vs W: 1.18 (1.03–1.35)
Mehta et al, 201722	Retrospective cohort	USA	Some cancer registries (Iowa, Alabama, California, and North Carolina)	3250	N/A	1851: 1399	W: 2089 B/AA: 512 A: 256 H: 241 Other: 182	B/AA vs W: 0.88 (0.80–0.98) A vs W: 0.82 (0.73–0.95) H vs W: 0.97 (0.88–1.08)
Vyfhuis et al, 201723	Retrospective cohort	USA	National Cancer Database	113,945	66.3	65,370: 48,575	W: 88,896 B/AA: 13,587 Other: 11,462	Stage III, B/AA vs W: 0.97 (0.96–0.98) Stage IV B/AA vs W: 0.97 (0.96–0.97)
Wu et al, 202024	Retrospective cohort	China	SEER Database	133,263	67	63,232: 70,031	W: 97,781 B/AA: 15,693 API: 11,651 H: 8138	B/AA vs W: 1.03 (1.01–1.05) API vs W: 0.71 (0.69–0.73) H vs W: 0.91 (0.89–0.94)
Zeng et al, 202125	Retrospective cohort	USA	SEER Database	61,961	68	32,323: 29,638	W: 46,896 B/AA: 7928 API: 6989 Other: 148	B/AA vs W: 0.97 (0.94–1.00) API vs W: 0.90 (0.88– 0.93)
Duncan et al, 202426	Retrospective cohort	USA	Indiana University Simon Comprehensive Cancer Center Registry	3349	N/A	1728: 1621	W: 2941 B/AA: 408	B/AA vs W: 2.39 (1.65–3.46)

A indicates Asian; API, Asian/Pacific Islander; B/AA, Black/African American; CI, confidence interval; F, female; H, Hispanic; HR, hazard ratio; M, male; N/A, not available; NSCLC, non–small cell lung cancer; SEER, Surveillance, Epidemiology and End Results Program; W, White.

Racial disparities in the overall survival of patients with NSCLC

Asian vs White

This forest plot in Figure 2a presents a meta-analysis comparing survival outcomes between Asian and White patients with NSCLC, using White patients as the reference group. The pooled hazard ratio (HR) was 0.86, with a 95% CI of 0.79 to 0.94 and a statistically significant P value (<0.01), indicating that Asian patients had better OS than White patients. Individual studies displayed HR ranging from 0.55 to 0.96, with weights assigned based on study size and precision; Tannenbaum et al¹⁹ contributed the most weight to the analysis. The heterogeneity among the studies was moderate, with an I² value of 37%, suggesting some variability in effect size between studies. Overall, the pooled HR reflects a survival benefit for Asian patients relative to White patients in this meta-analysis.

Figure 2.

Forest plots of the meta-analyses in (a) Asian vs White, (b) API vs White, (c) Black vs White, and (d) Hispanic vs White patients with non–small cell lung cancer.

API vs White

This forest plot in Figure 2b presents a meta-analysis comparing survival outcomes between API and White patients with NSCLC, using White patients as the reference group. The pooled HR was 0.80, with a 95% CI of 0.69 to 0.93 and a P value of <0.01, indicating a statistically significant survival advantage for API patients. Individual studies showed HR ranging from 0.71 to 0.90, with Wu et al²⁴ and Zeng et al²⁵ contributing the highest weights at 37.8% each, reflecting their larger sample sizes or greater precision. Brzezniak et al²⁰ had a weight of 24.4%, contributing less to the pooled estimate. The heterogeneity among studies was high, with an I² value of 99%, suggesting substantial variability in the effect sizes across studies, which may be due to differences in study populations or methodologies. The pooled HR reflects an OS benefit for API patients relative to White patients in this analysis.

Black vs White

The forest plot in Figure 2c presents a meta-analysis comparing survival outcomes between Black and White patients with NSCLC, with White patients as the reference group. The pooled HR was 1.00, with a 95% CI of 0.94 to 1.07 and a P value of <0.01, indicating no statistically significant difference in survival between Black and White patients. Individual studies displayed a range of HR, some above 1.0 and others below, reflecting varying survival outcomes across studies. The analysis exhibited high heterogeneity among the included studies, as indicated by an I² value of 93%, suggesting variability in results across studies due to differences in study design, patient populations, or other factors.

Hispanic vs White

This forest plot in Figure 2d presents a meta-analysis comparing survival outcomes between Hispanic and White patients with NSCLC, with White patients as the reference group. The pooled HR was 0.93, with a 95% CI of 0.87 to 1.00 and a P value of 0.19, indicating no statistically significant difference in survival between the two groups. Individual study HRs ranged from 0.91 to 1.16, with Wu et al²⁴ contributing the most weight at 69.8%, followed by Mehta et al²² at 26.7% and Brzezniak et al²⁰ at 3.5%, based on study size and precision. The heterogeneity across studies was moderate, with an I² value of 39%, suggesting some variability in effect size among the studies. The overall pooled HR reflects no significant survival advantage or disadvantage for Hispanic patients relative to White patients in this analysis. Funnel plots of the meta-analyses are shown in Figure 3.

Figure 3.

Funnel plots of the meta-analyses in (a) Asian vs White, (b) API vs White, (c) Black vs White, and (d) Hispanic vs White patients with non–small cell lung cancer.

Survival outcome disparity by initial staging in Black patients

Stage I NSCLC in Black vs White patients

The forest plot in Figure 4a presents a meta-analysis comparing survival outcomes between Black and White patients with stage I NSCLC, with White patients as the reference group. The pooled HR was 1.11, with a 95% CI of 1.00 to 1.23 and a P value of <0.01, indicating no statistically significant difference in survival between Black and White patients at this stage. Individual study HRs ranged from 1.05 to 1.18, with Saeed et al¹³ and Wu et al²⁴ contributing the largest weights at 48.2% and 45.2%, respectively, reflecting their influence on the pooled estimate. The analysis showed high heterogeneity, with an I² value of 84%, suggesting substantial variability among the studies included, potentially due to differences in study design or population characteristics.

Figure 4.

Forest plots of the meta-analyses in Black vs White patients with (a) stage I, (b) stage II, (c) stage III, and (d) stage IV non–small cell lung cancer.

Stage II NSCLC in Black vs White patients

The forest plot in Figure 4b presents a meta-analysis comparing survival outcomes between Black and White patients with stage II NSCLC, with White patients serving as the reference group. The pooled HR was 1.03, with a 95% CI of 0.96 to 1.10 and a P value of 0.26, indicating no statistically significant difference in survival between Black and White patients at this stage. Individual study HRs ranged from 0.98 to 1.37, with Saeed et al¹⁴ contributing the most weight at 56.6%, followed by Wu et al²⁴ at 41.6%. The study by Duncan et al²⁶ had a higher HR of 1.37 but contributed only 1.8% to the analysis due to a wide CI. The analysis showed low heterogeneity, with an I² value of 26%, indicating minimal variability in effect sizes across studies. The overall pooled HR suggests no significant difference in survival outcomes between Black and White patients with stage II NSCLC.

Stage III NSCLC in Black vs White patients

The forest plot in Figure 4c presents a meta-analysis comparing survival outcomes between Black and White patients with stage III NSCLC, using White patients as the reference group. The pooled HR was 1.04, with a 95% CI of 0.96 to 1.12 and a P value of <0.01, indicating no statistically significant difference in survival between Black and White patients at this stage. Individual study HRs ranged from 0.97 to 1.15, with Vyfhuis et al²³ contributing the largest weight at 31.7%, followed by Saeed et al¹³ at 30.4%. Duncan et al²⁶ had a higher HR of 1.15 but contributed only 8.6% to the analysis due to a wide CI. The analysis showed high heterogeneity, with an I² value of 96%. The overall pooled HR suggests no significant survival difference between Black and White patients with stage III NSCLC in this analysis.

Stage IV NSCLC in Black vs White patients

The forest plot in Figure 4d presents a meta-analysis comparing survival outcomes between Black and White patients with stage IV NSCLC, with White patients serving as the reference group. The pooled HR was 1.02, with a 95% CI of 0.97 to 1.07 and a P value of <0.01, indicating no statistically significant difference in survival between Black and White patients at this stage. Individual study HRs ranged from 0.97 to 1.14, with Vyfhuis et al²³ contributing the largest weight at 33.3%, followed by Saeed et al¹³ and Wu et al,²⁴ each contributing around 30%. Duncan et al²⁶ had a higher HR of 1.14 but contributed only 6.1% to the analysis due to a wider CI. The analysis showed high heterogeneity, with an I² value of 94%, indicating substantial variability in effect sizes across studies. The overall pooled HR suggests no significant survival difference between Black and White patients with stage IV NSCLC in this meta-analysis. Funnel plots of the meta-analyses based on stage are shown in Figure 5.

Figure 5.

Funnel plots of the meta-analyses in Black vs White patients with (a) stage I, (b) stage II, (c) stage III, and (d) stage IV non–small cell lung cancer.

DISCUSSION

Our meta-analysis revealed that Asian and API populations experienced more favorable outcomes than White individuals, while Black and Hispanic populations had similar outcomes compared to White individuals. This finding reveals racial disparities in NSCLC, underscoring the need for further investigation into genetic, biological, and socioeconomic health care factors that may contribute to these differences. The increased proportions of minority races from the included studies expanded the external validity of our results. Although previous studies reported Asian or API ancestry with lower survival rates,²⁸ multiple factors may explain why our results differed. Variations in genomic alterations and histologic subtypes might improve survival. Lung adenocarcinoma is more prevalent in API populations (54.5% vs 41.2% to 44.1%), with actionable driver genomic aberrations, such as EGFR or ALK, occurring more frequently.²⁵ Zhao et al reported improved OS in those with mutated EGFR compared to wild-type EGFR (17.5 vs 9.7 months; HR, 1.72; 95% CI, 1.36–2.17; P < 0.001).²⁷ Chi et al demonstrated markedly higher 3-year OS rates in patients with stage IV lung adenocarcinoma harboring EGFR mutations or ALK rearrangements treated with tyrosine kinase inhibitors (48.0% to 57.0% and 73.0% to 76.9%) compared to those without actionable mutations (9.7% to 18.1%).²⁹ The differences in genomic alterations and histologic subtypes may also account for similar survival outcomes, despite adverse social determinants of health affecting healthcare access.

Of the 15 studies included in our meta-analysis, five analyzed NSCLC by histologic subtype (adenocarcinoma, large cell carcinoma, squamous cell carcinoma, and NSCLC not otherwise specified) and race. Three studies^14,17,20 found no difference in lung cancer–specific survival between races across NSCLC histologic subtypes. However, Vyfhuis et al observed that Black individuals had significantly improved OS compared to White individuals in adenocarcinoma, squamous cell carcinoma, and NSCLC not otherwise specified.²³ Conversely, Saeed et al reported that Hispanic White individuals tended to have a higher incidence of NSCLC histologic subtypes associated with a significantly lower mortality risk compared to White individuals.¹³

Previous studies reported lower survival rates in Black patients with NSCLC compared to White patients due to socioeconomic factors and higher smoking prevalence.²⁴ Wannaphut et al also reported that a meta-analysis revealed Black patients receiving immunotherapy had better OS outcomes compared to White patients.³⁰ However, our meta-analysis found no significant difference in OS between these groups. This may reflect the widespread use of targeted therapies and immunotherapies, which reduces the disparities observed in earlier studies. Studies indicated that Black patients with advanced-stage NSCLC experienced worse survival outcomes due to lower systemic therapy rates.^9,26 Vyfhuis et al noted a slight improvement in survival among Black patients compared to White patients in advanced-stage NSCLC, suggesting that advancements in personalized treatment may narrow gaps.³¹ Furthermore, studies adjusting for health care access demonstrated similar survival rates between Black and White patients, indicating that equitable care mitigates disparities.^32–35

In previous studies, Black patients with stage I NSCLC were reported to have higher mortality rates than White patients, partially attributed to lower rates of surgical intervention.^12,17,36,37 Socioeconomic factors have also been implicated in survival disparities, particularly in advanced-stage disease.²⁶ Interestingly, White patients may have lower survival outcomes in stage I disease, possibly due to a higher prevalence of KRAS mutations, which are linked to poor survival outcomes.^38–40 Conversely, Black patients have been shown in some reports to have a lower incidence of EGFR and KRAS mutations, both of which are linked to outcomes and response to targeted therapies.^41,42 However, more recent data by Araujo et al indicated that the incidence of these mutations may be similar between Black and White patients, suggesting that genetic differences may not fully explain survival disparities.^41,42 Our meta-analysis found no significant differences in racial disparities in survival outcomes between patients with early-stage and late-stage NSCLC. This may reflect advancements in treatment strategies, including the broader availability and utilization of targeted therapies and immunotherapies. Future studies should focus on evaluating tumor mutational profiles and treatment responses in uniformly treated cohorts to better understand the interplay of biological and systemic factors in influencing survival disparities.

Our study has limitations. Most included studies were observational, limiting causal inference. Nonetheless, consistent findings across large samples enhance robustness. Population heterogeneity, including differences in treatment type, smoking, and histology, may act as confounders.^35,43–45 Still, our pooled analysis reflects a broad patient spectrum. Notably, the prevalence of key mutations such as EGFR and ALK in Asian and Hispanic populations aligns with observed survival patterns.^27,38,46 A lack of survival data for Native American, Alaska Native, and Pacific Islander groups highlights a gap in current literature. Last, while the limited number of studies may reduce power, our findings offer critical insight into evolving trends in racial disparities in NSCLC.

CONCLUSION

The analysis indicates that Asian and API patients with NSCLC exhibit superior OS outcomes compared to White patients, whereas racial disparities in survival outcomes are statistically insignificant for Black and Hispanic patients. Additionally, staging disparities in OS were not observed between Black and White patients with NSCLC.

Disclosure statement/Funding

The authors report no funding or conflicts of interest.