Download Temporal Trends in Demographics and Overall Survival of Non

Special Report
Temporal Trends in Demographics and Overall
Survival of Non–Small-Cell Lung Cancer Patients
at Moffitt Cancer Center From 1986 to 2008
Matthew B. Schabath, PhD, Zachary J. Thompson, PhD, and Jhanelle E. Gray, MD
Background: An assessment of historical trends in patient survival is important to determine the progress
toward patient outcomes and to reveal where advancements must be made. The goal of this study was to assess
changes in demographics and overall survival of non–small-cell lung cancer (NSCLC) patients who were seen
at Moffitt Cancer Center spanning 22 years.
Methods: This analysis included 4,997 NSCLC patients who were treated at our institute over 5 time periods: 1986
to 1988, 1991 to 1993, 1996 to 1998, 2001 to 2003, and 2006 to 2008. Kaplan-Meier survival curves and the
log-rank statistic were used to assess changes in 5-year survival rates over the 5 time periods, and multivariable
hazard ratios were estimated from Cox proportional hazards models.
Results: From 1986 to 2008 we observed statistically significant increases in the percentage of patients over the
age of 70 years, women, never-smokers and former smokers, and patients with stage I tumors. Over the same time
period the median survival time statistically significantly increased from 1.09 years (95% confidence interval [CI],
0.95–1.34, P < .001) to 2.27 years (95% CI, 2.07–2.46, P < .001), and the overall 5-year survival rate for all patients
significantly increased from 14.7% to 31.1% (P < .001). Among stage I patients, the 5-year survival rate increased from 31.7% to 54.0% (P < .001), 13.3% to 36.0% for stage II (P < .001), 10.5% to 21.7% for stage III
(P < .001), and 3.4% to 9.6% for stage IV (P < .001).
Conclusions: This analysis demonstrated important temporal changes in the demographics and improvements
in overall survival of NSCLC patients treated at our institute from 1986 to 2008. The 5-year survival rates and
median survival time of patients diagnosed with NSCLC has significantly improved across all stages, including patients with late-stage disease.
Introduction
In the United States, lung cancer is the second most
common cancer in men after prostate cancer and the
second most common cancer in women after breast
cancer. In 2013 an estimated 228,190 new cases of
lung cancer were diagnosed in the United States, accounting for about 14% of all cancer diagnoses.1 The
incidence rate has been declining in men over the
past 2 decades, but in women the incidence rate has
just recently started to decrease. Lung cancer is the
leading cause of cancer-related death among both
men and women in the United States, and it accounts
for more deaths than any other cancer in both sexes.
In 2013 approximately 159,480 deaths occurred, or
From the Departments of Cancer Epidemiology (MBS) and Biostatistics (ZJT) and the Thoracic Oncology Program (JEG) at the
H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida.
Submitted August 26, 2013; accepted August 26, 2013.
Address correspondence to Matthew B. Schabath, PhD. Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL 33612. E-mail: Matthew.
[email protected]
No significant relationship exists between the authors and the
companies/organizations whose products or services may be referenced in this article.
January 2014, Vol. 21, No. 1
about 27% of all cancer deaths. Lung cancer causes
more deaths annually than prostate, breast, colon,
and pancreatic cancers combined.1 Non–small-cell
lung cancer (NSCLC) represents more than 80% of
lung cancer diagnoses and has an overall 5-year survival rate of approximately 16%, which decreases
precipitously among patients diagnosed with latestage disease.2,3
An assessment of historical trends in patient
survival is an important evaluation to determine the
progress toward patient outcomes and reveal where
advancements must be made. To date, few studies
have evaluated survival trends over time in patients
with lung cancer. The goal of this study was to assess
changes in demographics and overall survival of
NSCLC patients across 5 time periods spanning 22
years who were seen at Moffitt Cancer Center (MCC).
Material and Methods
Study Population
This analysis included 4,997 NSCLC patients who were
treated at our institute between 1986 and 2008. The
5 periods that were selected for analysis were 1986
to 1988, 1991 to 1993, 1996 to 1998, 2001 to 2003,
Cancer Control 51
and 2006 to 2008. These time period ranges were
selected to compare changes in demographics and
overall survival within and across decades. Each study
period included 3 years of patient data with a 2- to
3-year interval in between. This research was approved by the University of South Florida Institutional
Review Board.
Cancer Registry Data
The primary source of data for this analysis was MCC’s
Cancer Registry, which abstracts information from patient electronic medical records on demographics, history of smoking, stage, histology, and treatment. Patients
seen for second opinions are not included in the Cancer
Registry database because they do not fall under current
Table 1. — Demographic and Clinical Characteristics of the NSCLC Patients (N = 4,997) for 5 Time Periods
Characteristic
Age, n (%)
< 50 yrs
50 to 59 yrs
60 to 69 yrs
≥ 70 yrs
Sex, n (%)
Male
Female
Smoking Status, n (%) Never
Former
Current
Race, n (%)
White
Black
Other or unknown
Ethnicity, n (%)
Non-Spanish
Spanish
Unknown
1986 to 1988
(n = 207)
1991 to 1993
(n = 379)
1996 to 1998
(n = 792)
2001 to 2003
(n = 1,669)
2006 to 2008
(n = 1,950)
P Valueb
< .001
24
52
90
41
(11.6)
(25.1)
(43.5)
(19.8)
42
66
166
105
(11.1)
(17.4)
(43.8)
(27.7)
74
133
281
304
(9.3)
(16.8)
(35.5)
(38.4)
165
361
556
587
(9.9)
(21.6)
(33.3)
(35.2)
165
376
660
748
(8.5)
(19.3)
(33.9)
(38.4)
< .001
133 (64.3)
74 (35.7)
212 (55.9)
167 (44.1)
422 (53.3)
370 (46.7)
896 (53.7)
773 (46.3)
957 (49.1)
993 (50.9)
11 (5.3)
84 (40.6)
99 (47.8)
31 (8.2)
167 (44.1)
172 (45.4)
51 (6.4)
439 (55.4)
292 (36.9)
111 (6.7)
856 (51.3)
586 (35.1)
140 (7.2)
1006 (51.6)
551 (28.3)
< .001
.008c
203 (98.1)
4 (1.9)
0 (0)
367 (96.8)
10 (2.6)
2 (0.5)
771 (97.3)
14 (1.8)
7 (0.9)
1605 (96.2)
49 (2.9)
15 (0.9)
1817 (93.2)
81 (4.2)
52 (2.7)
.025d
203 (98.1)
4 (1.9)
0 (0)
375 (98.9)
4 (1.1)
0 (0)
776 (98)
15 (1.9)
1 (0.1)
1612 (96.6)
50 (3)
7 (0.4)
1856 (95.2)
68 (3.5)
26 (1.3)
Histology, n (%)
Adenocarcinoma
Squamous cell carcinoma
Other NSCLC
89 (43.0)
76 (36.7)
42 (20.3)
167 (44.1)
139 (36.7)
73 (19.3)
382 (48.2)
225 (28.4)
185 (23.4)
697 (41.8)
431 (25.8)
541 (32.4)
751 (38.5)
389 (19.9)
810 (41.5)
Stage, n (%)
I
II
III
IV
N/A
41
15
77
61
13
(19.8)
(7.2)
(37.2)
(29.5)
(6.3)
79
40
136
100
24
(20.8)
(10.6)
(35.9)
(26.4)
(6.3)
223
56
268
211
34
(28.2)
(7.1)
(33.8)
(26.6)
(4.3)
419
161
450
495
144
(25.1)
(9.6)
(27)
(29.7)
(8.6)
532
135
446
521
316
(27.3)
(6.9)
(22.9)
(26.7)
(16.2)
First Course of Treatment, n (%)a
Combination
Surgery
Chemotherapy
Radiation
None
N/A
56
55
12
62
22
0
(27.1)
(26.6)
(5.8)
(30)
(10.6)
(0)
102
112
30
115
20
0
(26.9)
(29.6)
(7.9)
(30.3)
(5.3)
(0)
324
241
117
67
42
1
(40.9)
(30.4)
(14.8)
(8.5)
(5.3)
(0.1)
706
485
207
110
102
59
(42.3)
(29.1)
(12.4)
(6.6)
(6.1)
(3.5)
691
461
228
129
105
336
(35.4)
(23.6)
(11.7)
(6.6)
(5.4)
(17.2)
< .001
< .001e
< .001e
N/A = not available. NSCLC = Non–small-cell lung cancer.
P values in bold font indicate a statistically significant difference across the 5 time periods. Because of missing data or rounding, percentages may not
total 100.
a
First course of treatment includes all methods of treatment recorded in the treatment plan and administered to the patient before disease progression or
recurrence. Combination is treatment with 2 or more of surgery, chemotherapy, of radiation.
b P values calculated from Pearson’s chi-square to test for differences across the 5 time periods.
c Excludes “Other or unknown” group.
d
Excludes “Unknown” group.
e
Excludes “N/A” group.
52 Cancer Control
January 2014, Vol. 21, No. 1
Table 2. — Median Survival Time and 5-Year Survival Rate for 5 Time Periods
Median survival time, yrs
(95% CI)a
1986 to 1988
(N = 207)
1991 to 1993
(N = 379)
1996 to 1998
(N = 791)
2001 to 2003
(N = 1,668)
2006 to 2008
(N= 1,806)
P Valueb
1.09 (0.95–1.34)
1.20 (1.07–1.49)
1.71 (1.53–1.93)
1.82 (1.66–2.01)
2.27 (2.07–2.46)
< .001
14.7
14.2
21.1
26.5
31.1
< .001
31.7
13.3
10.5
3.4
36.7
22.5
5.5
3.0
48.0
30.4
11.6
3.8
54.3
35.3
15.0
6.3
54.0
36.0
21.7
9.6
< .001
< .001
< .001
< .001
5-year survival rate, %
Overall
By stage
I
II
III
IV
CI = confidence interval.
P values in bold font indicate a statistically significant difference across the 5 time periods.
a Median survival time was calculated from the Kaplan-Meier survival curves.
b P values calculated from the log-rank test.
reportable state and/or federal guidelines. Follow-up
for survival and vital status information occurs annually through passive and active methods. The Cancer
Registry defines “first course of treatment” as all methods of treatment recorded in the treatment plan and
administered to the patient before disease progression
or recurrence or death. For this analysis smoking status
was categorized as self-reported current smoker, former
smoker, or never-smoker. Where available, pathological
TNM staging was utilized, and if these data were missing, we utilized clinical stage information.
(P < .001), the percentage of squamous cell carcinoma decreased from 36.7% to 19.9% (P < .001), and
the percentage of stage I patients increased 19.8% to
27.3% (P < .001). Although the percentage of surgeries remained relatively constant for the first course
of treatment (26.6% to 23.6%), the actual number of
surgical patients increased from 55 in the 1986 to 1988
time period to 461 in the 2006 to 2008 time period.
Furthermore, combination first course of treatment,
which would include surgical patients who received
adjuvant chemotherapy, increased significantly (27.1%
to 35.4%, P < .001).
Complete follow-up data were not available on
all patients. The number of patients with complete
follow-up data per time period is noted in Table 2
and Fig 1. From 1986 to 2008 among all NSCLC patients, the median survival time statistically significantly increased (P < .001) from 1.09 years (95% CI,
0.95–1.34) to 2.27 years (95% CI, 2.07–2.46), and the
overall 5-year survival rate significantly increased
January 2014, Vol. 21, No. 1
0.8
0.6
0.4
Survival Probability
0.2
For this analysis, 4,997 NSCLC patients were
available across the 5 time periods: 1986 to 1988
(n = 207), 1991 to 1993 (n = 379), 1996 to 1998
(n = 792), 2001 to 2003 (n = 1,669), and 2006 to
2008 (n = 1,950). The demographics and 5-year
survival data across the 5 time periods are presented in Table 1. From 1986 to 2008, the percentage of patients who were diagnosed over the
age of 70 years increased from 19.8% to 38.4%
(P < .001), the percentage of women increased
from 35.7% to 50.9% (P < .001), the percentage of
current smokers decreased from 47.8% to 28.3%
Log Rank P value < .001
1986 to 1988 (N = 207)
1991 to 1993 (N = 379)
1996 to 1998 (N = 791)
2001 to 2003 (N = 1,668)
2006 to 2008 (N = 1,806)
0.0
Results
1.0
Statistical Analysis
Pearson’s chi-square was used to test for differences
in the patient characteristics across the 5 time groups.
Overall survival was right-censored at 5 years, and
survival analyses were performed using Kaplan-Meier
survival curves and the log-rank statistic. Multivariable Cox proportional hazard regression was utilized
to generate hazard ratio (HR) and 95% confidence
interval (CI) for each time period. All statistical
analyses were performed using R version 2.14
(R Project for Statistical Computing, www.rproject.org).
0
1
2
3
4
5
Years
Fig 1. — Kaplan-Meier survival curves for overall survival of non–small-cell lung
cancer patients by time period.
Cancer Control 53
Log Rank P value < .001
0.2
0.4
0.6
0.8
1986 to 1988 (N = 56)
1991 to 1993 (N = 119)
1996 to 1998 (N = 279)
2001 to 2003 (N = 580)
2006 to 2008 (N = 667)
0.0
Survival Probability
1.0
(P < .001) from 14.7% to 31.1% (Table 2). Although
there was no substantial difference in the overall
5-year rate for the first 2 time periods (14.7% for
1986 to 1988 vs 14.2% for 1991 to 1993), the 5-year
Kaplan-Meier survival curves (Fig 1) demonstrated
statistically significantly improved survival across the
5 time periods (P < .001). When the data were strati-
0
1
2
A
3
4
1.0
Log Rank P value < .001
0.4
0.6
0.8
1986 to 1988 (N = 77)
1991 to 1993 (N = 136)
1996 to 1998 (N = 268)
2001 to 2003 (N = 449)
2006 to 2008 (N = 446)
0.2
Survival Probability
5
Years
fied by stage, we observed increases in the 5-year
survival rates for each stage. The 5-year survival rate
increased from 31.7% to 54.0% for stage I patients
(P < .001), 13.3% to 36.0% for stage II (P < .001), 10.5%
to 21.7% for stage III (P < .001), and 3.4% to 9.6%
for stage IV (P < .001). The 5-year survival rates for
the 2 most recent time periods were nearly the same
for stage I (54.3% for 2001 to 2003 vs 54.0% for
2006 to 2008) and stage II patients (35.3% for 2001
to 2003 vs 36.0% for 2006 to 2008). As noted in
Fig 2A, when stage I and II patients were combined, the 5-year survival curves demonstrated
statistically significantly improved survival across
the 5 time periods (P < .001). Similarly, 5-year survival curves demonstrated statistically significantly
improved survival across the 5 time periods for
stage III (Fig 2B, P < .001) and stage IV (Fig 2C,
P < .001) patients.
Table 3 presents the multivariable hazard ratio (mHR) models for all covariates for each time
period. Across the 5 time periods, an increased
risk of death was generally observed for patients
older than 70 years of age, men, and current smokers. Patients treated with radiation were generally
associated with an elevated risk of death across
the 5 time periods, and increasing stage for each
of the time periods was associated with an incremental increased risk of death. For example, in
the 2006 to 2008 time period, the mHR was 1.81
(95% CI, 1.36–2.41) for stage II patients, 2.72 (95%
CI, 2.19–3.38) for stage III patients, and 5.17 (95%
CI, 4.15–6.45) for stage IV patients.
0.0
Discussion
0
1
2
B
3
5
1.0
0.2
0.4
0.6
0.8
Log Rank P value < .001
1986 to 1988 (N = 61)
1991 to 1993 (N = 100)
1996 to 1998 (N = 210)
2001 to 2003 (N = 495)
2006 to 2008 (N = 521)
0.0
Survival Probability
4
Years
0
C
1
2
3
4
5
Years
Fig 2A-C. — Stage-specific Kaplan-Meier survival curves for overall survival of
non–small-cell lung cancer patients by time period: (A) Kaplan-Meier survival curve
for stages I and II lung cancer, (B) Kaplan-Meier survival curve for stage III
lung cancer, and (C) Kaplan-Meier survival curve for stage IV lung cancer.
54 Cancer Control
This analysis of Cancer Registry data from 5 time
periods of lung cancer patients at our institute
demonstrates statistically significant changes in
demographics and survival of NSCLC patients over
the past 22 years. Most importantly, from 1986 to
2008, the overall median survival time and overall
5-year survival rate have both more than doubled.
Additionally, we observed statistically significant
increases in stage-specific 5-year survival rates
over the 5 time periods.
The most recent Surveillance, Epidemiology,
and End Results (SEER) monograph on lung cancer, published in 2007, reported overall and stagespecific survival rates based on patients diagnosed
between 1998 to 2001 from 12 SEER areas.4 Since
none of the 5 time periods in our study completely
overlapped with the time period in the SEER study,
we explored the 1998 to 2001 time period in our
data so we could make comparisons. The overall
5-year survival for SEER was 15.5% vs 25.0% in
our data, and the stage-specific rates in the SEER
study vs our study were 56.9% vs 52.4% for stage I,
January 2014, Vol. 21, No. 1
33.7% vs 33.6% for stage II, 9.4% vs 14.9% for stage III,
and 9.4% vs 3.9% for stage IV. Thus, the SEER results
are comparable with the rates found in our analysis,
especially among stage I, II, and III patients.
Other studies have also analyzed the temporal
changes in lung cancer survival, but our study is by
far the largest from a single institution. An analysis performed at the University of Texas MD Anderson Cancer Center5 over 3 study periods (1985
to 1989, 1993 to 1997, and 2000 to 2004) found
that the overall median survival duration increased
from 12.0 months in 1985 to 1989 to 17.5 months
in 2000 to 2004. Additionally, that study reported
that the probability of survival of patients who
were alive at 2 years after diagnosis increased from
26.5% in 1985 to 1989 to 40.8% in 2000 to 2004.
A Japanese study6 compared the survival of lung
cancer patients who were detected by screening
conducted between 1976 and 1984 with patients
who were detected by screening between 1989
and 1997 and reported an increase in both median
survival time of 27.8 months to 49.8 months and
an increase in 5-year survival from 34.8% to 47.8%
(P < .01). Two studies in Canada used national databases to assess temporal changes in cancer survival
rates. A recent study by Kachuri et al7 assessed temporal changes across 4 time periods (1992 to 1994,
1996 to 1998, 2000 to 2002, and 2005 to 2007) and
Table 3. — Multivariable Cox Proportional Hazard Models for 5 Time Periods
1986 to 1988
mHR (95% CI)
1991 to 1993
mHR (95% CI)
1996 to 1998
mHR (95% CI)
2001 to 2003
mHR (95% CI)
2006 to 2008
mHR (95% CI)
Age (yrs)
< 50
50 to 59
60 to 69
≥ 70
1.00 (referent)
0.83 (0.47–1.47)
1.06 (0.62–1.80)
1.74 (0.94–3.24)
1.00 (referent)
1.24 (0.75–2.03)
1.28 (0.84–1.96)
1.85 (1.17–2.91)
1.00 (referent)
1.29 (0.92–1.83)
1.34 (0.97–1.84)
1.73 (1.25–2.41)
1.00 (referent)
1.00 (0.79–1.25)
0.95 (0.77–1.19)
1.28 (1.02–1.60)
1.00 (referent)
0.93 (0.72–1.20)
1.03 (0.81–1.32)
1.16 (0.90–1.48)
Sex
Female
Male
1.00 (referent)
1.21 (0.84–1.73)
1.00 (referent)
1.58 (1.23– 2.03)
1.00 (referent)
1.42 (1.19–1.68)
1.00 (referent)
1.39 (1.23–1.58)
1.00 (referent)
1.24 (1.09–1.41)
Smoking Status
Never
Former
Current
1.00 (referent)
1.04 (0.47–2.31)
0.96 (0.44–2.10)
1.00 (referent)
1.10 (0.69–1.74)
1.16 (0.74–1.83)
1.00 (referent)
1.03 (0.72–1.47)
1.38 (0.96–1.98)
1.00 (referent)
1.14 (0.89–1.47)
1.34 (1.03–1.74)
1.00 (referent)
1.39 (1.08–1.79)
1.72 (1.32–2.25)
Race
White
Black
Other or unknown
1.00 (referent)
2.92 (0.85–9.97)
N/A
1.00 (referent)
2.41 (1.20–4.88)
2.87 (0.67–12.31)
1.00 (referent)
0.60 (0.29–1.24)
1.51 (0.69–3.28)
1.00 (referent)
1.21 (0.83–1.76)
1.87 (0.99–3.53)
1.00 (referent)
1.52 (1.14–2.02)
0.76 (0.48–1.19)
Ethnicity
Non-Spanish
Spanish
Unknown
1.00 (referent)
0.33 (.07–1.56)
N/A
1.00 (referent)
1.58 (0.48–5.17)
N/A
1.00 (referent)
0.84 (0.45–1.59)
0.88 (0.12–6.56)
1.00 (referent)
0.90 (0.64–1.25)
1.41 (0.58–3.43)
1.00 (referent)
1.19 (0.86–1.65)
2.14 (1.14–4.04)
Histology
Adenocarcinoma
Squamous cell carcinoma
Other NSCLC
1.00 (referent)
0.79 (0.54–1.17)
0.98 (0.62–1.57)
1.00 (referent)
0.85 (0.63–1.13)
1.01 (0.73–1.40)
1.00 (referent)
0.93 (0.76–1.14)
0.96 (0.77–1.20)
1.00 (referent)
0.92 (0.79–1.08)
0.88 (0.77–1.02)
1.00 (referent)
1.10 (0.92–1.31)
0.92 (0.80–1.07)
First Course of Treatmenta
Combination
Surgery
Chemotherapy
Radiation
1.00 (referent)
0.37 (0.19–0.72)
0.71 (0.34–1.47)
1.37 (0.90–2.09)
1.00 (referent)
0.86 (0.57–1.29)
1.30 (0.82–2.05)
1.51 (1.10–2.06)
1.00 (referent)
0.88 (0.67–1.17)
1.41 (1.09–1.82)
2.45 (1.82–3.31)
1.00 (referent)
0.70 (0.57–0.85)
1.40 (1.17–1.67)
2.52 (1.98–3.20)
1.00 (referent)
0.86 (0.70–1.07)
1.19 (0.99–1.42)
2.59 (2.03–3.29)
Stage
I
II
III
IV
1.00 (referent)
1.06 (0.48–2.34)
1.01 (0.52–1.95)
1.87 (0.96–3.64)
1.00 (referent)
1.40 (0.86–2.26)
2.76 (1.79–4.24)
5.40 (3.28–8.89)
1.00 (referent)
1.55 (1.04–2.33)
3.33 (2.49–4.46)
5.26 (3.83–7.23)
1.00 (referent)
1.40 (1.08–1.82)
2.38 (1.92–2.96)
4.30 (3.46–5.36)
1.00 (referent)
1.81 (1.36–2.41)
2.72 (2.19–3.38)
5.17 (4.15–6.45)
CI = confidence interval, N/A = not available, NSCLC = non–small-cell lung cancer, mHR = multivariable hazard ratio.
Bold font indicates a statistically significant hazard ratio.
a
First course of treatment includes all methods of treatment recorded in the treatment plan and administered to the patient before disease progression
or recurrence.
January 2014, Vol. 21, No. 1
Cancer Control 55
found only a 2.6% absolute difference in the 5-year
age-standardized relative survival ratios for all lung
cancers combined. An earlier study conducted in
Canada8 analyzed survival trends across 5 time periods (1969 to 1973, 1974 to 1978, 1979 to 1983, 1984
to 1988, and 1989 to 1991) and found no significant
differences across the study periods. Unfortunately,
neither Canadian study presented stage-specific results and combined all lung cancers together rather
than focusing on specific histological subtypes.
The multivariable models in the present analysis
revealed that older patients, men, current smokers, and
late-stage patients were associated with an increased
risk of death. The findings for age, sex, and smoking
status have been reported in previous studies,3-5 and
tumor stage is a well-documented prognostic and predictive factor for NSCLC.9-11 First course of treatment
with radiation was also associated with an increased
risk of death. Kachroo et al8 reported a similar finding for radiation therapy where patients treated with
radiation only were associated with a 3.9-fold (95%
CI, 1.12–13.33) increased risk of death. Lung cancer
patients who receive radiotherapy typically have more
advanced disease (eg, postoperative stage IIIA, unresectable stage IIIA/B, stage IV). Additionally, some
early-stage lung cancer patients are also referred for
radiotherapy if they have poor performance status and
are not surgical candidates. Thus, the increased risk of
death among patients who receive radiotherapy likely
reflects the poor performance status and inherent poor
prognosis of the patients rather than the treatment
itself. We also observed that surgery-only patients were
generally associated with a reduced risk of death. This
finding is not unexpected since surgery is the typical
treatment for early-stage NSCLC patients with good
performance status.
A few limitations must be acknowledged about
this study. First, we acknowledge the possible lack
of generalizability of our study population because
the lung cancer patients in this analysis were derived
from a single cancer care center and were composed
of mostly non–Hispanic whites. Hence, the results may
not be generalizable to community practices or even
to other cancer centers. However, we must consider
that lung cancer patients at a tertiary cancer center
like MCC could represent more complex cases, and
thus our 5-year survival rates could be conservative.
This is speculation since we do not have demographic
and 5-year survival data for regional practices. Additionally, our analysis was limited to Cancer Registry
data, which does not include a comprehensive and
systematic assessment of lung cancer risk factors such
as detailed smoking history, family history of cancer,
occupational exposures, and medical history. The data
abstracted by Cancer Registry are limited to information that is available in patient medical records.
56 Cancer Control
Conclusions
This analysis demonstrated important temporal
changes in the demographics and improvements in
overall survival of non–small-cell lung cancer patients
treated at Moffitt Cancer Center from 1986 to 2008.
The 5-year survival rates and median survival times
of patients diagnosed with non–small-cell lung cancer
have significantly improved across all stages, including late-stage disease. The observed improvement in
lung cancer survival over the last 22 years is likely
attributed to several factors including advancements
in surgery, chemotherapy regimens, management
of comorbidities, and a slightly higher percentage
of early-stage patients who are more amendable to
treatment. Further study is required to assess potential temporal changes in targeted molecular-based
therapies, advancements in surgical procedures, and
patients enrolled into chemotherapy trials.
This work was supported was by a National Institutes of
Health/National Cancer Institutive (NIH/NCI) Specialized
Program of Research Excellence (SPORE) Grant (P50
CA119997) and an NIH/NCI American Recovery and Reinvestment Act (ARRA) Grant (5 UC2 CA 148322-02). For
contributions in data collection, curation, management,
and access, appreciation is expressed to the Moffitt Cancer
Registry (Director: Karen A. Coyne), Edward T. Chwieseni,
Research Information Technology (IT), and the Data Management and Integration Technology (DMIT) group.
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January 2014, Vol. 21, No. 1