Abstract A145: Racial and ethnic disparities in survival outcomes among young adults with non-small cell lung cancer: A Surveillance, Epidemiology, and End Results (SEER) analysis

Abstract Introduction: Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancer cases. NSCLC in young adults, defined here as age <50 years at diagnosis, is relatively uncommon. This study aimed to evaluate racial and ethnic disparities in survival outcomes among young adults with NSCLC. Methods: Using the SEER 17 database, we identified patients diagnosed with NSCLC from 2013-2023 and aged 18-49 years at diagnosis. Cases reported by death certificate or autopsy or with missing data were excluded. Chi-square tests were used to assess differences in the distribution of demographic and clinicopathologic characteristics across the racial/ethnic groups. One- and five-year survival rates were estimated using Kaplan-Meier methods. Cox proportional hazards models were used to assess mortality risk by race/ethnicity, adjusting for sex, age, stage, histology, receipt of surgery, household income, and prior cancer. Results: Among the 9,819 patients included in this analysis, 56.7% identified as non-Hispanic White (NHW), 14.6% as non-Hispanic Asian or Pacific Islander (NHAPI), 14.2% as Hispanic, 13.9% as non-Hispanic Black (NHB), and 0.5% as non-Hispanic American Indian or Alaska Native (NHAIAN). The distributions of sex, age, histology, and stage at diagnosis significantly differed across the racial/ethnic groups (p<.001). NHAIAN patients had the highest proportion of females (62.7%), while NHB patients had the lowest (48.4%). Hispanic patients had the highest proportion of individuals diagnosed before age 40 years (30%). Adenocarcinoma was the most common histologic subtype overall (64%), with the highest proportion among NHAPI patients (82.5%) and the lowest among NHW patients (59.1%). Overall, 61.1% of patients were diagnosed with distant-stage disease, with the highest proportion among NHAPI patients (75.2%), followed by NHB (63.8%), Hispanic (63.5%), NHW (56.3%), and NHAIAN (52.9%) patients. The 1-year survival rate was highest among NHAPI patients (76.4%, 95% CI 74.4–78.5), followed by Hispanic (71.6%, 95% CI 69.5–73.9), NHW (64.6%, 95% CI 63.5–65.7), NHAIAN (58.9%, CI: 48.3–71.9), and NHB (56.9%, 95% CI 54.6–59.3) patients. Similarly, the 5-year survival rate was highest among NHAPI patients (40.1%, 95% CI 37.4–42.9), followed by NHW (39.4%, 95% CI 38.2–40.7), Hispanic (38.7%, 95% CI 36.1–41.6), NHB (31.0%, 95% CI 28.7–33.5), and NHAIAN (29.1%, 95% CI 19.4–43.8) patients. In adjusted models, NHB patients had a higher mortality risk than NHW patients (hazard ratio [HR] 1.10, 95% CI 1.02-1.19; p=.017). Lower adjusted mortality risks were observed among Hispanic (HR 0.90, 95% CI 0.82-0.98; p=.013) and NHAPI (HR 0.73, 95% CI 0.67-0.79; p<.001) patients, compared to NHW patients. There was no significant difference in mortality risk between NHAIAN and NHW patients (HR 1.41, 95% CI 0.99-2.01; p=.058). Conclusion: Significant racial and ethnic disparities in survival exist among young adults with NSCLC. Further studies are needed to investigate the drivers of these disparities and inform the development of targeted interventions. Citation Format: Carissa M. Feliciano, Kinsley Wang, Robert C. Hsu. Racial and ethnic disparities in survival outcomes among young adults with non-small cell lung cancer: A Surveillance, Epidemiology, and End Results (SEER) analysis [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A145.