Skip to main content

Advertisement

SpringerLink
Log in

Progress in the Treatment and Outcomes for Early-Stage Non-Small Cell Lung Cancer

  • LUNG CANCER
  • Published:
Lung Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to assess temporal trends in population-based treatment and survival rates in patients with early-stage non-small cell lung cancer (NSCLC).

Methods

Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Chi-square test, Kaplan–Meier method, and Cox regression models were employed in SPSS 23.0.

Results

Fifty-seven thousand and eighty-eight NSCLC patients with early-stage disease from 1988 to 2014 were identified. 6409 (11.2%) were diagnosed in 1988–1994, 5800 (10.2%) 1995–1999, 13,031 (22.8%) 2000–2004, 15,786 (27.7%) 2005–2009, and 16,062 (28.1%) 2010–2014. We observed a significant increase in the proportion of older patients, adenocarcinoma histology, and rate of wedge resection over the study period. The five-year overall survival (OS) for the entire cohort was 63.3%. Those undergoing resection without adjuvant therapy had the highest outcomes. Lobectomy was associated with better outcomes compared to wedge resection or pneumonectomy. A significant difference in five-year OS by year of diagnosis (1988–1994: 58.8% vs. 1995–1999: 60.6% vs. 2000–2004: 63.2% vs. 2005–2009: 66.1%; p < 0.001) was observed. This significant OS difference was also observed regardless of age, surgery type, and T stage, but also only in those with adenocarcinoma. On multivariable analysis, year of diagnosis, age, gender, race, treatment and surgery type, histology, T stage, and tumor grade remained independent prognostic factors for OS.

Conclusions

Overall survival for early-stage NSCLC has significantly improved over the recent decades despite an increasing proportion of older patients and those undergoing sublobar resection or SBRT. This finding may be limited to those with adenocarcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A (2017) Cancer statistics. CA Cancer J Clin 67:7–30

    Article  PubMed  Google Scholar 

  2. Church TR, Black WC, Aberle DR et al (2013) Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med 368:1980–1991

    Article  PubMed  Google Scholar 

  3. Flores RM, Park BJ, Dycoco J et al (2009) Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer. J Thorac Cardiovasc Surg 138:11–18

    Article  PubMed  Google Scholar 

  4. Nakamura H, Kawasaki N, Taguchi M et al (2005) Survival following lobectomy vs limited resection for stage I lung cancer: a meta-analysis. Br J Cancer 92:1033–1037

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Timmerman R, Paulus R, Galvin J et al (2010) Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 303:1070–1076

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Overview of the surveillance, epidemiology, and end results (SEER) Program. National Cancer Institute. https://seer.cancer.gov/about/overview.html. Accessed 23 May 2017

  7. Detterbeck FC, Chansky K, Groome P et al (2016) The IASLC lung cancer staging project: methodology and validation used in the development of proposals for revision of the stage classification of NSCLC in the forthcoming (eighth) edition of the TNM classification of lung cancer. J Thorac Oncol 11:1433–1446

    Article  PubMed  Google Scholar 

  8. Ginsberg RJ, Rubinstein LV (1995) Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 60:615–622 discussion 622–613.

    Article  CAS  PubMed  Google Scholar 

  9. Keenan RJ, Landreneau RJ, Maley RH Jr., et al (2004) Segmental resection spares pulmonary function in patients with stage I lung cancer. Ann Thorac Surg 78:228–233; discussion 228–233

    Article  PubMed  Google Scholar 

  10. Kilic A, Schuchert MJ, Pettiford BL et al (2009) Anatomic segmentectomy for stage I non-small cell lung cancer in the elderly. Ann Thorac Surg 87:1662–1666; discussion 1667–1668

    Article  PubMed  Google Scholar 

  11. Grills IS, Mangona VS, Welsh R et al (2010) Outcomes after stereotactic lung radiotherapy or wedge resection for stage I non-small-cell lung cancer. J Clin Oncol 28:928–935

    Article  PubMed  Google Scholar 

  12. Raz DJ, Zell JA, Ou SH et al (2007) Natural history of stage I non-small cell lung cancer: implications for early detection. Chest 132:193–199

    Article  PubMed  Google Scholar 

  13. Wisnivesky JP, Bonomi M, Henschke C et al (2005) Radiation therapy for the treatment of unresected stage I–II non-small cell lung cancer. Chest 128:1461–1467

    Article  PubMed  Google Scholar 

  14. Chang JY, Senan S, Paul MA et al (2015) Stereotactic ablative radiotherapy versus lobectomy for operable stage I non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Oncol 16:630–637

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kenfield SA, Wei EK, Stampfer MJ et al (2008) Comparison of aspects of smoking among the four histological types of lung cancer. Tob Control 17:198–204

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Holford TR, Levy DT, McKay LA et al (2014) Patterns of birth cohort-specific smoking histories, 1965–2009. Am J Prev Med 46:e31–e37

    Article  Google Scholar 

  17. Meza R, Meernik C, Jeon J et al (2015) Lung cancer incidence trends by gender, race and histology in the United States, 1973–2010. PLoS ONE 10:e0121323

    Article  PubMed  PubMed Central  Google Scholar 

  18. Patel JD, Hensing TA, Rademaker A et al (2009) Phase II study of pemetrexed and carboplatin plus bevacizumab with maintenance pemetrexed and bevacizumab as first-line therapy for nonsquamous non-small-cell lung cancer. J Clin Oncol 27:3284–3289

    Article  CAS  PubMed  Google Scholar 

  19. Mok TS, Wu YL, Thongprasert S et al (2009) Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 361:947–957

    Article  CAS  PubMed  Google Scholar 

  20. Hoyert DL (2012) 75 Years of Mortality in the United States, 1935–2010. Age 88:1400

    Google Scholar 

  21. Gridelli C, Langer C, Maione P et al (2007) Lung cancer in the elderly. J Clin Oncol 25:1898–1907

    Article  PubMed  Google Scholar 

  22. Mery CM, Pappas AN, Bueno R et al (2005) Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the surveillance, epidemiology, and end results database. Chest 128:237–245

    Article  PubMed  Google Scholar 

  23. Palma D, Visser O, Lagerwaard FJ et al (2010) Impact of introducing stereotactic lung radiotherapy for elderly patients with stage I non-small-cell lung cancer: a population-based time-trend analysis. J Clin Oncol 28:5153–5159

    Article  PubMed  Google Scholar 

  24. Fernandez FG, Furnary AP, Kosinski AS et al (2016) Longitudinal follow-up of lung cancer resection from the society of thoracic surgeons general thoracic surgery database in patients 65 years and older. Ann Thorac Surg 101:2067–2076

    Article  PubMed  Google Scholar 

  25. Eguchi T, Bains S, Lee MC et al (2017) Impact of increasing age on cause-specific mortality and morbidity in patients with stage I non-small-cell lung cancer: a competing risks analysis. J Clin Oncol 35:281–290

    Article  PubMed  Google Scholar 

  26. Pignon JP, Tribodet H, Scagliotti GV et al (2008) Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol 26:3552–3559

    Article  PubMed  Google Scholar 

  27. Strauss GM, Herndon JE 2nd, Maddaus MA et al (2008) Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups. J Clin Oncol 26:5043–5051

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Guidelines Version NCCN. 2.2018. Non-small cell lung cancer. National Comprehensive Cancer Network. December 19, 2017. Accessed January 13, 2018

  29. Feinstein AR, Sosin DM, Wells CK (1985) The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med 312:1604–1608

    Article  CAS  PubMed  Google Scholar 

  30. Dinan MA, Curtis LH, Carpenter WR et al (2012) Stage migration, selection bias, and survival associated with the adoption of positron emission tomography among medicare beneficiaries with non-small-cell lung cancer, 1998–2003. J Clin Oncol 30:2725–2730

    Article  PubMed  Google Scholar 

  31. Navani N, Nankivell M, Lawrence DR et al (2015) Lung cancer diagnosis and staging with endobronchial ultrasound-guided transbronchial needle aspiration compared with conventional approaches: an open-label, pragmatic, randomised controlled trial. Lancet Respir Med 3:282–289

    Article  PubMed  PubMed Central  Google Scholar 

  32. Bradley J, Thorstad WL, Mutic S et al (2004) Impact of FDG-PET on radiation therapy volume delineation in non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 59:78–86

    Article  PubMed  Google Scholar 

  33. Kawaguchi T, Takada M, Kubo A et al (2010) Performance status and smoking status are independent favorable prognostic factors for survival in non-small cell lung cancer: a comprehensive analysis of 26,957 patients with NSCLC. J Thorac Oncol 5:620–630

    Article  PubMed  Google Scholar 

  34. Battafarano RJ, Piccirillo JF, Meyers BF et al (2002) Impact of comorbidity on survival after surgical resection in patients with stage I non-small cell lung cancer. J Thorac Cardiovasc Surg 123:280–287

    Article  PubMed  Google Scholar 

  35. Reck M, Rodriguez-Abreu D, Robinson AG et al (2016) Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med 375:1823–1833

    Article  CAS  PubMed  Google Scholar 

  36. Brugger W, Triller N, Blasinska-Morawiec M et al (2011) Prospective molecular marker analyses of EGFR and KRAS from a randomized, placebo-controlled study of erlotinib maintenance therapy in advanced non-small-cell lung cancer. J Clin Oncol 29:4113–4120

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Rush University Medical Center, 500 S. Paulina St., Chicago, IL, 60612, USA

    Jacob Y. Shin, Ja Kyoung Yoon & Gaurav Marwaha

Authors
  1. Jacob Y. Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ja Kyoung Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gaurav Marwaha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacob Y. Shin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Informed consent was not required as our article does not contain any studies with human participants.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 37 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shin, J.Y., Yoon, J.K. & Marwaha, G. Progress in the Treatment and Outcomes for Early-Stage Non-Small Cell Lung Cancer. Lung 196, 351–358 (2018). https://doi.org/10.1007/s00408-018-0110-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-018-0110-1

Keywords

Search

Navigation