Journal List > J Lung Cancer > v.6(2) > 1050673

Kim, Kwon, Oh, Kim, Kim, Ryu, Yum, Yong, Lee, Lee, Lee, Lee, Jung, Jeong, and In: National Survey of Lung Cancer in Korea, 2005

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.

Conclusion

Adenocarcinoma was found to be the most frequent histopathologic type, and active treatments were found to improve the survival of patients with lung cancer, even when they were in advanced stages or elderly.

References

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Fig. 1.
Web based case report form.
jlc-6-67f1.tif
Fig. 2.
Proportion (%) of regional population and registered patients with lung cancer. GG: Gyeonggy, GN: Gyeongnam, GB: Gyeongbuk, CC: Chungcheong, JN: Jeonnam, JB: Jeon-buk, GW: Gangwon, JJ: Jeju.
jlc-6-67f2.tif
Fig. 3.
Proportion (%) of smokers (current or ex-smokers) and never smokers (never-sm) by sex and histopathologic type. ADC: adenocarcinoma, non-ADC: NSCLC other than ADC, SCLC: small cell lung carcinoma.
jlc-6-67f3.tif
Fig. 4.
Proportion (%) of histopathologic types compared to survey data of 1997(3). SQC: squamous cell carcinoma, ADC: adenocarcinoma, LCC: large cell carcinoma, NSCLC: non-small cell lung carcinoma, SCLC: small cell lung carcinoma.
jlc-6-67f4.tif
Fig. 5.
Distribution (%) of stage at diagnosis compared to survey data of 1997(3).
jlc-6-67f5.tif
Fig. 6.
Overall survival of 8788 lung cancer patients by age group (A), by sex (B), by histopathologic types; ADC (adenocarcinoma), Non ADC (non-adenocarcinoma NSCLC), SCLC (small cell lung cancer) (C), by stage in NSCLC (D), by stage in SCLC (E) and by performance status (F). Y axis represent survival.
jlc-6-67f6.tif
Fig. 7.
Treatment group (TG) showed superior survival compared to supportive group (SG) not only in all patients (A), but also in patients with stage IV NSCLC (B) and patients older than 75 years (C). Y axis represent survival.
jlc-6-67f7.tif
Table 1.
Characteristics of Patients by Age Group
% 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)

* CI: confidence interval

Statistical significances between age groups: p<0.001

Table 2.
Independent Prognostic Factors by Cox Proportional Hazard Model
Non-small cell lung Ca. OR 95% conf. interval Significance
Age (<50, 50∼75, >75) 1.29 1.15∼1.45 p<0.001
Female (0) vs. male (1) 1.39 1.21∼1.60 p<0.001
PS score (ECOG 0∼1, 2∼4) 1.79 1.59∼2.02 p<0.001
Stage (Ia∼ IV) 2.17 2.00∼2.35 p<0.001
ADC (0) vs. non ADC (1) 1.28 1.14∼1.44 p<0.001
No treat (0) vs. treatment (1) 0.61 0.54∼0.70 p<0.001
Small cell lung ca. OR 95% conf. interval Significance
Age (<50, 50∼75, >75) 1.26 1.00∼1.59 p=0.049
PS score (ECOG 0∼1, 2∼4) 1.79 1.40∼2.28 p<0.001
Stage (Limited, extensive) 1.76 1.39∼2.24 p<0.001
No treat (0), treatment (1) 0.45 0.32∼0.63 p<0.001
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