Abstract B144: Nativity status and non-small cell lung cancer outcomes

Abstract Introduction: Epidemiologic studies have identified disparities in non-small cell lung cancer (NSCLC) outcomes based on race and ethnicity. However, little is known about the impact of nativity status on NSCLC outcomes particularly across different driver mutation subsets. Methods: We identified patients with NSCLC evaluated at a single U.S. institution between 2008-2025. The cohort included individuals who underwent next-generation sequencing with the Stanford Actionable Mutation Panel on their incident tumor and who had data on nativity status available by chart review. Nativity status was defined based on whether patients were U.S. born or foreign born. Overall survival (OS) was evaluated from the time of diagnosis using the Kaplan-Meier method. Multivariable Cox regression compared OS after adjusting for age, sex, race/ethnicity, stage, and therapies received (surgery, radiation, chemotherapy, immunotherapy, and/or targeted therapy). Results: Among 964 patients queried, 717 had data available on nativity status. The median age at diagnosis was 70.0 years, 53.3% were female, 56.3% were ever smoking, and 42.0% had metastatic disease at diagnosis. In total, 361 (50.3%) patients were U.S. born and 356 (49.7%) patients were foreign born. Of patients who were foreign born, 78.4% were from Asia, 10.0% were from Latin America, 8.5% were from Europe, and 2.7% were from other global regions. While the majority of U.S. born patients were white (84.2%), the majority of foreign born patients were Asian (72.2%). Compared with U.S. born patients, those who were foreign born had a significantly greater proportion of tumors harboring EGFR mutations (49.4% vs. 21.6%, P<0.001) and significantly fewer KRAS mutations (15.7% vs. 30.7%, P<0.001). Overall, foreign born patients had a significantly improved OS compared with U.S. born patients (median 69.1 vs. 49.8 months, P=0.006). After adjusting for potential confounders, the association remained statistically significant (HR 0.74, 95% CI 0.56-0.96). Patients with stage I-III NSCLC who were foreign born had a significantly improved OS compared with those who were U.S. born (median 102.9 vs. 85.3 months, P<0.001), and patients with stage IV NSCLC showed a similar trend (median 30.7 vs 17.2 months, P=0.073). There were no significant differences in OS among patients with EGFR-mutated NSCLC based on nativity status (P=0.500). In contrast, patients with KRAS-mutated NSCLC who were foreign born had a significantly improved OS compared with those who were U.S. born (median 102.9 vs. 37.5 months, P=0.002), including on multivariable analysis (HR 0.54, 95% CI 0.30-0.97). Conclusion: In this study, patients who were foreign born demonstrated a significantly improved OS, which was most prominent among foreign born patients diagnosed with early-stage NSCLC. Frequencies of NSCLC driver mutations differed based on nativity status which translated to different patterns of OS within each mutation subset. Availability of targeted therapies may help to narrow disparate outcomes. Citation Format: Jacqueline V. Aredo, Joel W. Neal, Christian A. Kunder, Kavitha J. Ramchandran, Nathaniel J. Myall, Mohana Roy, Heather A. Wakelee. Nativity status and non-small cell lung cancer outcomes [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 B144.