Lung cancer survival in Spain and prognostic factors: A prospective, multiregional study
Introduction
In spite of improvement in diagnostic and staging tools and more widespread use of chemotherapy and thoracic radiotherapy against lung cancer in the last decade, long-term survival remains poor and there seem to be substantial differences in survival rates between European countries and regions [1]. However, most of the information about lung cancer survival comes from national cancer registries and there are important differences in the quality of data provided by some European countries in terms of disease definition, case collection, and follow-up. Therefore, as Butler et al. [2] have pointed out, variations in the published long-term survival between countries may be partially related to inclusion bias, insufficient collection data or differences in the statistical corrections applied or data presentation.
In Western countries, the age at diagnosis has risen rapidly and this trend will probably continue in the near future. However, few studies have focussed on the management of elderly patients and their survival, and some recent papers on the overall management of lung cancer show a high proportion of such patients receiving only palliative treatment [3], [4], [5], [6], [7]. The rising proportion of elderly patients and their high rate of comorbidity probably influence treatment approaches.
In Spain, epidemiological and clinical studies of lung cancer have only included small geographic areas [8], [9], [10], [11]. This is the first prospective, multiregional, clinical, and epidemiological study of lung cancer survival in Spain, encompassing eight different geographic regions. Preliminary results from the initial data collection phase on patient and disease characteristics have been reported [12]. The aim of this study was to analyse those results further in function of survival and to ascertain the main prognostic factors with special emphasis on patients older than 70 years.
Section snippets
Design
This prospective, observational, multicentre study of lung cancer survival recruited patients in eight Spanish regions with a total population of 2,211,381 (1,093,566 males and 1,117,815 females) at the beginning of 2003 based on figures compiled by the Spanish Institute of Statistics (http://www.ine.es). Twelve general hospitals participated in the initial collection data, although only 10 were able to adequately follow patients to record complete survival information for analysis in this
Results
Initially, a total of 1027 patients (922 males and 105 females) were included; of those, 13 patients (1.26%) were lost when they moved away from their usual place of residence. Thus, adequate information about 3-year survival was obtained for 1014 patients. Computed tomography scans were performed in 1007 of the 1027 enrolled (98.1%) patients. A cytohistologic specimen was obtained by fiberoptic bronchoscopy in 663 (64.6%), transthoracic fine needle aspiration in 150 (14.6%) and other
Discussion
Comparisons of lung cancer survival between countries are difficult because of variations in methodology, especially concerning the denominator used to calculate the survival rate [2], [14]. Therefore, a clear description of the method used is essential for understanding the outcomes. This study is the first prospective, multiregional, large-population-based investigation of overall lung cancer survival in Spain. In spite of the differences in size and technological resources between the 10
Conflict of interest statement
There are no conflicts of interest.
Acknowledgments
This project has been partially financed by grants from the Spanish Society of Pulmonology and Thoracis Surgery (SEPAR) and the Respiratory Society of Extremadura (SEAR).
The authors would like to thank to Dr. J. Zamorano (Unidad de Investigación. Hospital San Pedro de Alcántara, Cáceres) for scientific support and assistance in preparing this manuscript. M.E. Kerans assisted with the English expression in a version of the manuscript.
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