{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:15:40Z","timestamp":1784297740819,"version":"3.55.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T00:00:00Z","timestamp":1667865600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>We performed this study to evaluate the association of socioeconomic status (SES) factors with cancer-specific survival (CSS) of patients with non-small cell lung cancer (NSCLC). We further assessed the predictive value of a novel Tumor Node Metastasis (TNM)-SES staging system, combining the TNM stage with the SES stage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using the Surveillance, Epidemiology, and End Results (SEER) database, we selected 40,378 patients diagnosed with NSCLC from 2012 to 2016. Cox regression method and Harrell's concordance index (C-index) were performed to select the SES factors related to CSS and evaluate the predictive ability of the novel TNM-SES stage. We used Kaplan\u2013Meier curves and a log-rank test to conduct a survival analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified four SES factors (marriage, insurance, education, and household income) associated with CSS and constructed the SES stage (SES-1 and SES-2). NSCLC patients with SES-2 stage (low SES) was associated with young adult, black race, male, squamous carcinoma, upper lobe site, and advanced stage. SES-2 stage patients were significantly associated with a dismal prognosis of patients with NSCLC, with a 21.0% increased risk (HR = 1.21, 95%CI (1.18\u20131.24), <jats:italic>p<\/jats:italic> &amp;lt; <jats:italic>0.001<\/jats:italic>). The C-index of our novel TNM-SES stage was 0.732 [95% CI (0.728\u20130.736)], higher than the traditional TNM stage [0.717, 95% CI (0.715\u20130.719)], indicating superior predictive value.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:italic>Our population-based study indicated that SES was significantly associated with cancer staging and SCC in patients with NSCLC<\/jats:italic>. Our novel TNM-SES staging system showed a superior predictive value to the traditional TNM stage. The impact of SES on patients with NSCLC should receive more concern in clinical management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2022.992944","type":"journal-article","created":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T07:47:36Z","timestamp":1667893656000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Impact of socioeconomic status on cancer staging, survival in non-small cell lung 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