{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:11:02Z","timestamp":1760058662218,"version":"build-2065373602"},"reference-count":22,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T00:00:00Z","timestamp":1745020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Patients of Asian descent are often grouped together despite their diverse ethnicities and genetic backgrounds. Cancer outcomes result from a complex interplay of genetics, environment, and socioeconomic factors. This study aims to describe lung cancer survival outcome variations in Asian ethnic subgroups, hypothesizing that significant outcome differences exist between subgroups. Materials and Methods: A retrospective analysis of the 2020 National Cancer Database identified patients with stage IV non-small-cell lung cancer (NSCLC). Asian patients were subcategorized into nine groups: Chinese, Japanese, Korean, Asian Indian\/Pakistani, Vietnamese, Pacific Islander, Filipino, Laotian\/Hmong\/Kampuchean\/Thai, and Other Asian\/Asian not otherwise specified (NOS). The primary outcome was overall survival, and the secondary outcome was utilization of palliative care. Kaplan\u2013Meier analysis and multivariate Cox and logistic modeling were used to assess outcomes of interest. Results: A total of 23,747 Asian patients with stage IV NSCLC were identified. Demographic characteristics of the subgroups varied by age, sex, Charlson\u2013Deyo Comorbidity Index, and utilization of palliative care. Relative to Chinese Asians, multivariate Cox analysis showed worse survival outcomes among patients categorized as Japanese, Korean, Pacific Islanders, Filipino, and Laotian\/Hmong\/Kampuchean\/Thai. The rate of palliative care utilization also varied among Asian subgroups. Compared to Chinese patients, palliative care was more likely to be utilized by patients categorized as Japanese and Pacific Islander. Conclusions: Amongst Asian subgroups, variations in survival outcomes and palliative care utilization in stage IV NSCLC patients were observed. Surgeons should acknowledge these disparities and consider disaggregating Asian races in prognosis analysis to enhance understanding of race\u2019s impact on outcomes. Recognizing these differences is crucial for guiding personalized treatment strategies, optimizing resource allocation, and informing health policy to ensure equitable cancer care for all Asian populations.<\/jats:p>","DOI":"10.3390\/medicina61040753","type":"journal-article","created":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T20:31:36Z","timestamp":1745181096000},"page":"753","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variability in Survival Outcomes Among Asian Ethnic Groups with Stage IV NSCLC"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9740-7231","authenticated-orcid":false,"given":"Aria","family":"Bassiri","sequence":"first","affiliation":[{"name":"Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue-Lin","family":"Hu","sequence":"additional","affiliation":[{"name":"School of Medicine, Case Western Reserve University, 9501 Euclid Avenue, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3802-9055","authenticated-orcid":false,"given":"Christina","family":"Boutros","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6500-0613","authenticated-orcid":false,"given":"Boxiang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8851-7124","authenticated-orcid":false,"given":"Jillian","family":"Sinopoli","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonidas Tapias","family":"Vargas","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip A.","family":"Linden","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3850-8040","authenticated-orcid":false,"given":"Christopher W.","family":"Towe","sequence":"additional","affiliation":[{"name":"Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","unstructured":"American Cancer Society (2024, May 07). Cancer Facts and Statistics. Cancer Facts & Statistics. Available online: https:\/\/www.cancer.org\/research\/cancer-facts-statistics\/all-cancer-facts-figures\/2024-cancer-facts-figures.html."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1158\/1055-9965.EPI-19-0221","article-title":"Cancer Progress and Priorities: Lung Cancer","volume":"28","author":"Schabath","year":"2019","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1177\/107327481602300405","article-title":"Racial and Ethnic Differences in the Epidemiology and Genomics of Lung Cancer","volume":"23","author":"Schabath","year":"2016","journal-title":"Cancer Control"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S125","DOI":"10.2105\/AJPH.2009.163931","article-title":"Hidden breast cancer disparities in Asian women: Disaggregating incidence rates by ethnicity and migrant status","volume":"100","author":"Gomez","year":"2010","journal-title":"Am. J. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s10549-017-4229-1","article-title":"Breast cancer in Asian Americans in California, 1988\u20132013: Increasing incidence trends and recent data on breast cancer subtypes","volume":"164","author":"Gomez","year":"2017","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"421","DOI":"10.15585\/mmwr.mm7216a2","article-title":"Cancer Distribution Among Asian, Native Hawaiian, and Pacific Islander Subgroups\u2013United States, 2015\u20132019","volume":"72","author":"Bock","year":"2023","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.annepidem.2021.11.002","article-title":"Thyroid cancer incidence disparities among ethnic Asian American populations, 1990\u20132014","volume":"66","author":"Lee","year":"2022","journal-title":"Ann. Epidemiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1158\/2159-8290.CD-15-0344","article-title":"APOBEC Enzymes: Mutagenic Fuel for Cancer Evolution and Heterogeneity","volume":"5","author":"Swanton","year":"2015","journal-title":"Cancer Discov."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Shi, H., Seegobin, K., Heng, F., Zhou, K., Chen, R., Qin, H., Manochakian, R., Zhao, Y., and Lou, Y. (2022). Genomic landscape of lung adenocarcinomas in different races. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.946625"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1093\/jnci\/dji055","article-title":"Clinical and biological features associated with epidermal growth factor receptor gene mutations in lung cancers","volume":"97","author":"Shigematsu","year":"2005","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"287","DOI":"10.5732\/cjc.011.10106","article-title":"East meets West: Ethnic differences in epidemiology and clinical behaviors of lung cancer between East Asians and Caucasians","volume":"30","author":"Zhou","year":"2011","journal-title":"Chin. J. Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1097\/JTO.0000000000000251","article-title":"EGFR mutations in Asian patients with advanced lung adenocarcinoma","volume":"9","author":"Liam","year":"2014","journal-title":"J. Thorac. Oncol."},{"key":"ref_14","unstructured":"(2023, February 27). National Cancer Data Base. Available online: https:\/\/www.facs.org\/quality-programs\/cancer-programs\/national-cancer-database\/puf\/."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies","volume":"12","author":"Altman","year":"2014","journal-title":"Int. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1097\/JTO.0b013e31818ddff7","article-title":"Epidemiology of non-small cell lung cancer in Asian Americans: Incidence patterns among six subgroups by nativity","volume":"3","author":"Raz","year":"2008","journal-title":"J. Thorac. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1093\/jnci\/djab143","article-title":"Incidence of Lung Cancer Among Never-Smoking Asian American, Native Hawaiian, and Pacific Islander Females","volume":"114","author":"DeRouen","year":"2022","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1056\/NEJMoa0904554","article-title":"Screening for epidermal growth factor receptor mutations in lung cancer","volume":"361","author":"Rosell","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1148\/radiol.2021204691","article-title":"Racial and Ethnic Disparities in Lung Cancer Screening Eligibility","volume":"301","author":"Narayan","year":"2021","journal-title":"Radiology"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Cranford, H.M., Koru-Sengul, T., Lopes, G., and Pinheiro, P.S. (2023). Lung Cancer Incidence by Detailed Race\u2013Ethnicity. Cancers, 15.","DOI":"10.3390\/cancers15072164"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1002\/onco.13748","article-title":"Disparities in Cancer Care and the Asian American Population","volume":"26","author":"Lee","year":"2021","journal-title":"Oncologist"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e1255","DOI":"10.1200\/OP.22.00001","article-title":"Disaggregation of Asian American and Pacific Islander Women With Stage 0-II Breast Cancer Unmasks Disparities in Survival and Surgery-to-Radiation Intervals: A National Cancer Database Analysis From 2004 to 2017","volume":"18","author":"Taparra","year":"2022","journal-title":"JCO Oncol. Pract."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/753\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:17:46Z","timestamp":1760030266000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/4\/753"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,19]]},"references-count":22,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["medicina61040753"],"URL":"https:\/\/doi.org\/10.3390\/medicina61040753","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2025,4,19]]}}}