Abstract
Lung cancer ranks as the top cancer worldwide in terms of incidence and constitutes a major health problem. About 90% of lung cancer cases are diagnosed at advance stage where treatment is not available. Despite evidence that lung cancer screening improves survival, guidelines for lung cancer screening are still a subject for debate. In Saudi Arabia, only 14% of lung cancers are diagnosed at early stage and researches on survival and its predictors are lacking. This overview analysis was conducted on predictors of lung cancer mortality according to the two major cancer types, small-cell lung cancers (SCLCs) and non-small cell lung cancers (NSCLCs) in Saudi Arabia. A secondary data analysis was performed on small-cell lung cancers (SCLCs) and Non-small cell lung cancers (NSCLCs) registered in the Saudi Cancer Registry (SCR) for the period 2009–2013 to estimate predictors of mortality for both lung cancer types. A total of 404 cases (197 SCLC and 207 NSCLC) were included in the analysis, all Saudi nationals. A total of 213 (52.75%) deaths occurred among lung cancer patients, 108 (54.82%) among SCLCs and 105 (50.72%) among NCSLCs. Three quarter of patients are diagnosis with advance stage for both SCLC & NSCLC. Univariate analysis revealed higher mean age at diagnosis in dead patients compared to alive patients for SCLCs (p = 0.04); but not NSCLCs, a lower mortality for NSCLCs diagnosed in 2013 (p = 0.025) and a significant difference in stage of tumor (p = 0.006) and (p = 0.035) for both SCLC and NSCLC respectively. In multiple logistic regression, stage of tumor was a strong predictor of mortality, where distant metastasis increased morality by 6-fold (OR = 5.87, 95% CI: 2.01 — 17.19) in SCLC and by 3-fold (OR = 3.29, 95% CI: 1.22 — 8.85) in NSCLC, compared to localized tumors. Those with NSCLC who were diagnosed in 2013 were less likely to die by 64% compared to NSCLC diagnosed in 2009 (OR = 0.36, 95% CI: 0.14 — 0.93). Age, sex, topography and laterality were not associated with mortality for both types of lung cancer. We observed that the stage of the tumor is the strongest predictor of mortality for both SCLCs and NSCLs. This confirms the impact of diagnostic stage on survival. However, establishing Saudi-specific lung cancer screening guidelines will require further research on the benefits and harms of screening modalities in the Saudi population.
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References
Torre LA et al. Global cancer statistics, 2012. CA Cancer J Clin 2015;65(2):87–108.
Youlden DR, Cramb SM, Baade PD. The International Epidemiology of Lung Cancer: geographical distribution and secular trends. J Thorac Oncol 2008;3(8):819–31.
Gibson GJ et al. Respiratory health and disease in Europe: the new European Lung White Book. Eur Respir J 2013;42(3):559–63.
Müller-Hermelink HK., et al.. Pathology & genetics, tumours of the lung, pleura, thymus and heart. World Health Organization Classification of Tumors, IARC Press, Lyon, France, 2004: pp. 146–147.
Mathers CD, T Boerma, DM Fat. Global and regional causes of death. British medical bulletin, 2009: p. ldp028.
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLOS med 2006;3(11):e442.
Saudi Cancer Registry, Cancer Incidence Report. Saudi Health Council, 2013.
Ridge CA, McErlean AM, Ginsberg MS, Epidemiology of lung cancer. in Seminars in interventional radiology. 2013, Thieme Medical Publishers.
Roudi F, Population trends and challenges in the Middle East and North Africa. 2001.
Mourshed MV, Hediger, Lambert T, Gulf cooperation council health care: challenges and opportunities. Global competitiveness reports, 2006.
Ng M et al. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA 2014;311(2):183–92.
World Health Organization, WHO report on the global tobacco epidemic, 2015: Raising taxes on tobacco. 2015.
M Ellis P, Vandermeer R, Delays in the diagnosis of lung cancer, Journal of thoracic disease, 2011. 3(3): pp. 183–188.
Moyer VA. Screening for lung cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2014;160(5):330–8.
Kathuria H et al. Updates and controversies in the rapidly evolving field of lung cancer screening, early detection, and chemoprevention. Cancers 2014;6(2):1157–79.
Saudi Cancer Registry, Cancer Incidence Report. 2010.
Travis WD, Brambilla E, Geisinger KR. Histological grading in lung cancer: one system for all or separate systems for each histological type? Eur Respir J 2016;47(3):720–3.
Travis WD et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol 2015;10(9):1243–60.
Campobasso O et al. Survival rates of lung cancer according to histological type. Br J Cancer 1974;29(3):240.
Chansky K et al. The International Association for the Study of Lung Cancer Staging Project: prognostic factors and pathologic TNM stage in surgically managed non-small cell lung cancer. J Thorac Oncol 2009;4(7):792–801.
Tammemägi MC et al. Selection criteria for lung-cancer screening. N Engl J Med 2013;368(8):728–36.
Khuder SA. Effect of cigarette smoking on major histological types of lung cancer: a meta-analysis. Lung Cancer 2001;31(2):139–48.
Khuder SA et al. Effect of cigarette smoking on major histological types of lung cancer in men. Lung Cancer 1998;22(1):15–21.
Govindan R et al. Changing epidemiology of small-cell lung cancer in the United States over the last 30 years: analysis of the surveillance, epidemiologic, and end results database. J Clin Oncol 2006;24(28):4539–44.
Putila J, Remick SC, Guo NL. Combining clinical, pathological, and demographic factors refines prognosis of lung cancer: a population-based study. PLoS One 2011;6(2):e17493.
Sculier J-P, et al.. The impact of additional prognostic factors on survival and their relationship with the anatomical extent of disease expressed by the 6th Edition of the TNM Classification of Malignant Tumors and the proposals for the 7th Edition. Journal of Thoracic Oncology, 2008. 3(5): pp. 457–466.
Office for National Statistics, Cancer survival in England: adults diagnosed in 2009 to 2013, followed up to 2014, 2015.
Kandioler D et al. Growing clinical evidence for the interaction of the p53 genotype and response to induction chemotherapy in advanced non–small cell lung cancer. J Thorac Cardiovasc Surgery 2008;135(5):1036–41.
Esteller M et al. Detection of aberrant promoter hypermethylation of tumor suppressor genes in serum DNA from non-small cell lung cancer patients. Cancer Res 1999;59(1):67–70.
Tong J et al. Expression of p16 in non-small cell lung cancer and its prognostic significance: a meta-analysis of published literatures. Lung Cancer 2011;74(2):155–63.
Rosell R et al. K-ras genotypes and prognosis in non-small-cell lung cancer. Ann Oncol 1995;6(suppl 3):S15–20.
Lam VK et al. Obesity is associated with long-term improved survival in definitively treated locally advanced non-small cell lung cancer (NSCLC). Lung Cancer 2017;104:52–7.
Ou S-HI, Ziogas A, Zell JA. Prognostic factors for survival in extensive stage small cell lung cancer (ED-SCLC): the importance of smoking history, socioeconomic and marital statuses, and ethnicity. J Thorac Oncol 2009;4(1):37–43.
Alyson L Mahar CC, Lisa M McShane, Susan Halabi, Hisao Asamura, Ramon Rami-Porta, Patti A Groome, Refining prognosis in lung cancer: a report on the quality and relevance of clinical prognostic tools. Journal of Thoracic Oncology, 2015. 10(11): pp. 1576–1589.
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Alghamdi, H.I., Alshehri, A.F. & Farhat, G.N. An overview of mortality & predictors of small-cell and non-small cell lung cancer among Saudi patients. J Epidemiol Glob Health 7 (Suppl 1), S1–S6 (2017). https://doi.org/10.1016/j.jegh.2017.09.004
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DOI: https://doi.org/10.1016/j.jegh.2017.09.004