Abstract
Purpose
Lung Cancer has been the leading cause of cancer deaths in South Korea since the year 2000, and its incidence continues to rise. Here we report the result of national survey of lung cancer conducted by Korean association for the study of lung cancer (KASLC).
Materials and Methods
A total of 8,788 lung cancer patients diagnosed in 2005 were registered using a web based case report form issued to hospitals equipped with more than 400 beds.
Results
The age distribution ranged from 11 to 105 years (64.7±10.7 years), 75.8% (6,664) of the patients were male and 28.9% of patients were never smokers. Subjective symptoms at the time of diagnosis included coughing (3,350 patients), dyspnea (2,105), chest pain (1,067), hemoptysis (805), weight loss (789), general weakness (498) and hoarseness (190), while 12% (1,015) of patients had no subjective symptoms. Of the carcinomas grouped into non-small cell lung carcinoma (NSCLC), adenocarcinoma including bronchoalveolar cell carcinoma (1.3%) was the most frequent (36.1%) histopathologic type, followed by squamous cell lung carcinoma (32.1%), large cell carcinoma (1.5%), unclassified non-small cell carcinoma (13.2%) and others (3.7%). In addition, 13.5% of all of the patients were afflicted with small cell lung carcinoma (SCLC). The stage at diagnosis was IA (7.3%), IB (10.2%), IIA (1.3%), IIB (6.1%), IIIA (12.8%), IIIB (21.6%), and IV (40.6%) in the NSCLC group. In SCLC group, 44.6% of the patients were in the limited stage, while 55.4% of the patients were in the extensive stage. The initial treatments included surgery (22.1%), radiation therapy (7.8%), chemoradiation therapy (5.4%) and chemotherapy (38%), however, 26.6% of the patients were transferred or recorded to have supportive care only. Therefore we compared the outcomes of the Treatment Group (TG, 73.4%) and the Supportive Group (SG, 26.6%). The median survival time (MST) in months (m) was 28 (95% confidence interval 26.5∼29.5 m). Multivariate analysis indicated that the independent prognostic factors for NSCLC were age, gender, ECOG PS score, stage, histopathologic type, and treatment or supportive care. In the SCLC group, age, PS score, stage, treatment or supportive care were significant prognostic factors. The TG group showed significantly superior survival when compared to the SG group, even in patients with stage IV disease and in patients that were >75 years old.
References
1. Seo JH, Jeong CS. Death rate statistics of Korea, 2003: Korea National Statistical Office;. 2004.
2. Korean Cancer Registry. Annual report of the Koean Cancer Registry. 2005.
3. Scientific Committee of Korean Academy of Tuberculosis and Respiratory Diseases. The national survey of lung cancer in Korea. Tuberculosis and Respiratory Diseases. 1999; 46:455–465.
5. Straus GM, Jemal A, McKenna MB, Straus JA, Cummings KM. The epidemic of smoking-related adenocarcinoma of the lung: The role of the tobacco industry and filtered and low-tar cigarettes. J of Thoracic Oncology;. 2007. Sep; Seoul, Korea; 2007. p. S305.
6. Bach PB, Kelley MJ, Tate RC, McCrory DC. Screening for lung cancer: a review of the current literature. Chest. 2003; 123(1 Suppl):72S–82S.
7. Henschke CI, Naidich DP, Yankelevitz DF, et al. Early lung cancer action project: initial findings on repeat screenings. Cancer. 2001; 92:153–159.
8. The international early lung cancer action program investigators. International early lung cancer action program. [cited; Available from:. http://www.ielcap.org/.
9. NCI. National Lung Screening Trial. [cited; Available from:. http://www.cancer.gov/clinicaltrials/NCI-NLST#StudyIdInfo_CDR0000257938.
10. Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, Miettinen OS. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med. 2006; 355:1763–1771.
11. Chang A, Parikh P, Thongprasert S, et al. Gefitinib (IRESSA) in patients of Asian origin with refractory advanced nonsmall cell lung cancer: subset analysis from the ISEL study. J Thorac Oncol. 2006; 1:847–855.
12. Kim KS, Jeong JY, Kim YC, et al. Predictors of the response to gefitinib in refractory nonsmall cell lung cancer. Clin Cancer Res. 2005; 11:2244–2251.
13. Ou SH, Zell JA, Ziogas A, Anton-Culver H. Prognostic factors for survival of stage I nonsmall cell lung cancer patients: a population-based analysis of 19,702 stage I patients in the California Cancer Registry from 1989 to 2003. Cancer. 2007; 110:1532–1541.
Table 1.
% | All patients | <50 years | 50∼75 years | ≥75 years |
---|---|---|---|---|
Number (%) | 8,788 | 933 (10.6) | 6,647 (75.6) | 1,208 (13.7) |
Female | 24.2 | 40.3 | 21.6 | 26.1† |
Never smoker | 28.9 | 45.7 | 27.1 | 26.7† |
Adenocarcinoma | 37.5 | 61.7 | 35.6 | 30.2† |
I∼ II / III / IV | 25.0/34.5/40.6 | 24.2/24.2/51.6 | 25.7/34.9/39.4 | 21.3/40.6/28.0†† |
ECOG (0∼1) | 75.0 | 84.3 | 77.4 | 56.3†† |
Any treatment | 73.4 | 86.5 | 76.1 | 47.1†† |
Median survival (95% CI*) | 28.0 (26.5∼29.5) | Not reached | 29.0 m (26.5∼31.5) | 22.0 m† (19.2∼24.8) |