Washington University in St. Louis, St. Louis, MO
Aashray Singareddy , Mary Ellen Flanagan , Pamela Parker Samson , Saiama Naheed Waqar , Siddhartha Devarakonda , Jeffrey P. Ward , Brett Herzog , Anjali Rohatgi , Clifford Grant Robinson , Ramaswamy Govindan , Varun Puri , Daniel Morgensztern
Background: The American Cancer Society has recently reported an increase in the percentage of patients with localized lung cancer from 2004 to 2018 with a corresponding improvement in survival for all patients combined. We analyzed the recent trends in stage distribution for lung cancer including tumor and demographic factors. Methods: We selected patients with lung cancer from the National Cancer Database (NCDB) public benchmark report diagnosed between 2010 and 2017. Patients with unknown stage were excluded. Stage distribution using the AJCC 7th edition of the TNM system was evaluated according to year of diagnosis, histology, age, gender, race, insurance and income. Results: Among the 1,447,470 patients from 1,384 hospitals identified in the database, 56,382 (3.9%) were excluded due to unknown stage or incorrect histology, leaving 1,391,088 patients eligible. The percentage of patients with stage I progressively increased from 23.5% in 2010 to 29.1% in 2017 while stage IV decreased from 45.5% to 43.1% during the same period (Table). The increased in percentages of stage I from 2010 to 2017 were 25.9% to 31.8% in non-small cell lung cancer (NSCLC) and 5.0% to 5.4% in small cell lung cancer (SCLC). Although the increased percentage of stage I lung cancer was observed in all subsets of patients, there were significant imbalances according to demographic and socio-economic factors. In the year 2017, the major gaps in stage I included insurance (31.4% for Medicare, 26.4% for private insurance, and 12.9% for uninsured), income (32.4% for the highest annual income and 25.4% for the lowest) and race (29.9% in whites and 24.3% in blacks). Conclusions: There has been a significant increase in the percentage of stage I lung cancer at diagnosis from 2010 to 2017 which occurred mostly in NSCLC. Disparities in diagnosis and access to treatment may account for the differences in the percentage of patients with stage I among selected demographic populations. The staging trends and recent treatment improvements may lead to better survival for lung cancer.
Stage I | Stage II | Stage III | Stage IV | |
---|---|---|---|---|
2010 | 37,757 (23.5%) | 15,270 (9.5%) | 34,437 (21.5%) | 72,910 (45.5%) |
2011 | 39,077 (24.2%) | 15,071 (9.3%) | 34,640 (21.4%) | 72,817 (45.1%) |
2012 | 40,729 (24.5%) | 15,291 (9.2%) | 35,538 (21.4%) | 74,580 (44.9%) |
2013 | 43,279 (25.2%) | 15,838 (9.2%) | 35,462 (20.7%) | 76,859 (44.8%) |
2014 | 45,211 (25.7%) | 15,926 (9.0%) | 36,661 (20.8%) | 78,441 (44.5%) |
2015 | 48,855 (26.9%) | 16,393 (9.0%) | 37,055 (20.4%) | 79,605 (43.8%) |
2016 | 51,928 (28.1%) | 16,242 (8.8%) | 36,006 (19.5%) | 80,722 (43.7%) |
2017 | 54,793 (29.1%) | 16,278 (8.6%) | 36,258 (19.2%) | 81,159 (43.1%) |
Total | 361,629 (26.0%) | 126,309 (9.1%) | 286,057 (20.6%) | 617,093 (44.3%) |
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