Loretta Erhunmwunsee, MD Assistant Professor, Division of Thoracic Surgery, Department of Surgery; Assistant Professor, Division of Health Equities, Department of Population Sciences from the City of Hope speaks about Neighborhood Disadvantage Linked To Aggressive Non-small Cell Lung Cancer.
Link to Abstract:
https://www.abstractsonline.com/pp8/#!/9325/presentation/1832
Summary
The first paragraph is an introduction.
In the United States, lung cancer is the leading cause of cancer-related death. Though smoking is still the leading cause of non-small cell lung cancer (NSCLC), there is less research on the role of negative social circumstances and neighborhood socioeconomic status (nSES) in the production of particular NSCLC somatic mutations. Economic, housing, education, transportation, and environmental factors may all have an effect on neighborhood conditions. Understanding the connection between NSCLC biology and nSES is critical for addressing the disproportionately high rates of NSCLC incidence and poor outcomes in vulnerable communities in the United States. Although neighborhood deprivation indices have been linked to aggressive biology in other cancers, there is no evidence that they are linked to somatic mutations in NSCLC. The aim of this study is to see if there’s a connection between nSES exposure and somatic KRAS mutations, which are a marker of aggressive NSCLC biology.
Methodologies:
From 2015 to 2018, we looked at NSCLC patients who were treated at the City of Hope Comprehensive Cancer Center in Duarte, California, and who had somatic KRAS monitoring of their lung tumor tissue as part of their treatment. Data such as demographics and disease characteristics were extracted from the patients’ medical records. The California Health Places Index (HPI), the US Department of Housing and Urban Development Labor Market Engagement Index (LME), and the Area Deprivation Index were used to assign a census tract-level exposure to several indices of nSES conditions (ADI). To model the existence of somatic KRAS mutations in relation to exposure to various adverse nSES conditions, we used multiple logistic regressions. Age at diagnosis, sex, cigarette smoking, race/ethnicity, insurance status, cancer stage, cancer histology, and PM2.5 exposure were all factored into the odds ratios (ORs).
The following are the outcomes:
28 percent of 426 eligible NSCLC patients had a KRAS mutation, 54 percent were non-Hispanic White, 66 percent were in stage IV, and 83 percent had adenocarcinomas. Patients residing in areas with lower HPI scores (OR 1.92, 95 percent CI: 1.11 – 3.32) and lower LME had a slightly higher risk of a KRAS mutation (OR 1.16, 95 percent CI: 1.05 – 1.28). PM2.5, ADI, and other nSES indices were not substantially correlated with the possibility of a KRAS mutation in modified models.
Final Thoughts:
Patients with NSCLC who lived in poor neighborhoods as calculated by the California HPI and LME were more likely to have a somatic KRAS mutation, according to our findings. This connection suggests that nSES may be a key determinant of aggressive NSCLC biology. Our findings, on the other hand, suggest that deprivation is a dynamic combination of domains and regionally-specific factors. These results suggest that, in addition to nationally derived indexes like the ADI, future research should consider locally relevant nSES indicators as a complex marker of neighborhood conditions.