美国非洲裔美国人在肺癌的发病率和死亡率方面存在不成比例的影响。在驱动非小细胞肺癌 (NSCLC) 的致癌基因中，新兴证据表明由祖先影响的基因分子异质性导致了药物敏感性和治疗反应的可变性。本研究的目的是评估与种族相关的治疗决策、治疗结果和分子特征在KRAS 和 EGFR 突变致癌基因的 NSCLC 中的差异。本次回顾性研究使用美国健康系统的真实世界临床基因组数据，评估在晚期 KRAS 或 EGFR 驱动的 NSCLC 中的种族相关结果。我们的总体目标是评估与种族相关的治疗结果，并描述非西班牙裔黑人 (NHB) 和非西班牙裔白人 (NHW) NSCLC 患者的分子特征。共评估了723名 KRAS 突变型 NSCLC 患者和315名 EGFR 突变型患者。在 KRAS 突变型患者中，根据仅接受化疗或联合免疫检查点抑制剂的情况观察到 NHB 和 NHW 患者之间的不同治疗结果。与 NHW 患者相比，NHB 患者的治疗率明显较低。在 EGFR 突变型患者中，NHB 和 NHW 患者接受 EGFR 靶向药物的比率相似，总生存率没有显著差异。种族相关的分子特征差异包括 KRAS 突变型 NHB 患者的 TP53 同时突变频率较高，以及 NHB 患者中 EGFR G719S 亚型的较高患病率。在一个真实世界的 NSCLC 患者队列中，我们发现了与种族相关的治疗结果差异，并描述了 NHB 和 NHW 患者的分子特征。为了主动识别对系统治疗最有可能反应的患者，需要更全面的方法来帮助指导个体化患者人群的治疗选择。

African American individuals are disproportionately affected by lung cancer in terms of incidence and mortality. In oncogene-driven non-small-cell lung cancer (NSCLC), emerging evidence indicates that underlying molecular heterogeneity, which can be affected by ancestry, contributes to variable drug sensitivity and therapeutic responses. The purpose of this study was to evaluate race-associated differences in reported treatment decisions, therapeutic outcomes, and molecular features in KRAS- and EGFR-mutant NSCLC.This is a retrospective study using real-world clinical-genomic data from health systems in the United States to evaluate race-associated outcomes in advanced-stage KRAS- or EGFR-driven NSCLC. Our overall objectives were to evaluate race-associated therapeutic outcomes and to describe molecular features in non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients with NSCLC.A total of 723 NSCLC patients with KRAS and 315 patients with EGFR oncogenic mutations were evaluated. In KRAS-mutant patients, variable outcomes were observed in NHB and NHW patients on the basis of receiving chemotherapy alone or in combination with immune checkpoint inhibitors. NHB patients received treatment at significantly lower rates compared with NHW patients. In the EGFR-mutant cohort, NHB and NHW patients received EGFR-targeted agents at similar rates, and overall survival was not significantly different. Race-associated differences in molecular features included a higher frequency of TP53 comutation in KRAS-mutant NHB patients and higher prevalence of EGFR G719S subtype in NHB patients.In a real-world cohort of patients with NSCLC, we identified race-associated differences in therapeutic outcomes and described molecular characteristics in NHB and NHW patients with NSCLC. To proactively identify patients most likely to respond to systemic therapies, a more comprehensive approach is needed to help guide therapy selection in individualized patient populations.