Abstract 6222: Racial and socioeconomic influences on survival outcomes in small cell lung cancer: Analysis of concomitant radiation, immunotherapy, and demographic variables

Background: Small cell lung cancer (SCLC) is the most aggressive form of lung cancer, marked by rapid progression, frequent metastases, and poor survival rates. Real-world data from contemporary cohorts is vital to validate current treatments and develop novel hypotheses. SCLC staging typically depends on whether the disease can be encompassed within a definitive radiation field. Methods: A retrospective cohort study of 381 SCLC patients treated at a single center from January 1, 2014, to December 30, 2022, was conducted. Data included stage at diagnosis, race/ethnicity, treatment modalities (chemotherapy, radiation, and immunotherapy), and survival outcomes. Socioeconomic factors such as insurance status and lifestyle variables (e.g., alcohol and tobacco use) were analyzed. TNM staging was stratified into Early Limited Stage (E-LS, stages I-IIA), Advanced Limited Stage (A-LS, stages IIB-IIIC), and Extensive Stage (ES, stage IV). Results: Among the 381 patients, 54% were women, 51% were European American (EA), and 29% were African American (AA), the largest minority subgroup. Most (60%) presented with ES disease, while 20% had E-LS and 20% A-LS. Over 96% of patients had a history of smoking. AA patients were more likely to be insured through government programs (Medicare/Medicaid, 87% vs. 72% for EA, p=0.005) but had similar stage distributions. Notably, AA ancestry did not correlate with poorer survival compared to EA patients, unlike trends observed in other cancers. Radiation therapy combined with chemotherapy significantly improved survival in A-LS patients (median overall survival [OS]: 27.42 months vs. 7.5 months without radiation, p=0.0001). In E-LS patients, radiation showed a non-significant trend toward improved survival (median OS: 33.76 months vs. 23.77 months, p=0.09). In ES disease, where radiation was used palliatively or for oligometastatic control, there was no survival benefit (median OS: 6.93 months with radiation vs. 7.33 months without radiation, p=0.90). Immunotherapy significantly extended survival in ES-SCLC patients compared to those not receiving immunotherapy (p=0.03). Conclusion: This analysis highlights racial and socioeconomic factors in SCLC outcomes, showing AA patients, despite higher reliance on government insurance, had survival outcomes comparable to EA patients—unlike other cancers where disparities persist. Radiation therapy demonstrated the greatest survival benefit in A-LS patients, while its impact in other stages was limited. Citation Format: Helen Gandler, Pranay Adavelly, Parth Anil Desai. Racial and socioeconomic influences on survival outcomes in small cell lung cancer: Analysis of concomitant radiation, immunotherapy, and demographic variables [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 6222.