African American patients were more likely to not receive surgical resection for NSCLC than Caucasian patients (58% vs 31%, p=0.015), and race-neutral PFT equations did not alter eligibility.
Observational (n=127)
No
Does the use of race-neutral PFT equations change surgical eligibility compared to race-specific equations in patients with NSCLC?
While African American patients are less likely to undergo surgical resection for NSCLC than Caucasian patients, the retrospective application of race-neutral PFT equations would likely not have changed surgical eligibility.
p-value: p=0.406
Abstract Rationale Pulmonary function tests (PFTs) are used to assess surgical risk related to resection for non-small cell lung cancer (NSCLC). Historically, PFTs used race-specific Global Lung Initiative equations based on inaccurate assumptions of innate biological differences between races. In 2023, the ATS recommended using race-neutral equations as race-specific equations may misclassify lung function in African American (AA) patients, contributing to disparities in diagnosis, morbidity, and mortality. Conversely, race-neutral equations may lower FEV1 percent predicted, excluding more AA patients from potentially curative resection. Our study evaluated how PFTs influenced surgical ineligibility in NSCLC. Methods We conducted a single-center retrospective chart review at an urban Veterans Health Administration Medical Center. Patients in the lung cancer screening program diagnosed with NSCLC between January 1, 2016 and June 30, 2024 were included if evaluated for surgical resection. Sociodemographic, clinical, and spirometry data were collected, including FEV1 and DLCO from the most recent PFTs at diagnosis. Chart review identified documented reasons for surgical ineligibility. Results Among 127 patients with NSCLC, 114 had spirometry data. Of these, 55 (48.2%) underwent surgical resection, and 59 (51.8%) did not. The most common primary reasons for surgical ineligibility were cancer stage (33.9%), patient preference (20.3%), and comorbidities (13.6%), most commonly cardiac (5/7). PFTs were the primary reason for ineligibility in 5 patients (8.5%), 4 of whom were AA, and contributed to 10 cases (16.9%) overall. Among these, 5 (50%) had FEV1 40% (41.9 + 14.2%), and all but 2 were considered very high risk by DLCO 40% (34.9 + 17.1%). Using race-neutral equations, 90% (9/10) remained in the same risk category; 1 shifted from further testing to high risk. The average race-specific FEV1 was 42.29 + 14.28% versus 39.23 + 11.54% for race-neutral. AAs were less likely to undergo resection than Caucasian patients (χ2(1)=5.90, p = 0.015), with 58% (46/79) of AA patients versus 31% (8/26) of Caucasian patients not receiving surgery. Among AA patients, PFTs influenced eligibility for 8 patients and were among multiple reasons for 4, mirroring the trends of the overall cohort. Other reasons included patient preference, recent MI, functional status, and cancer stage. PFT equation type was not significantly associated with resection likelihood (χ2(1)=0.69, p = 0.406), regardless of race (p’s0.15). Conclusion AA patients were less likely than Caucasian patients to undergo surgical resection for NSCLC. PFTs impacted a very small subset of cases, and race-neutral equations would likely not have changed surgical eligibility. This abstract is funded by: None
Erp et al. (Fri,) conducted a observational in Non-small cell lung cancer (NSCLC) (n=127). Race-neutral PFT equations vs. Race-specific PFT equations was evaluated on Likelihood of undergoing surgical resection (p=0.406). African American patients were more likely to not receive surgical resection for NSCLC than Caucasian patients (58% vs 31%, p=0.015), and race-neutral PFT equations did not alter eligibility.
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