Elsevier

Lung Cancer

Volume 59, Issue 2, February 2008, Pages 246-254
Lung Cancer

Lung cancer survival in Spain and prognostic factors: A prospective, multiregional study

https://doi.org/10.1016/j.lungcan.2007.08.013Get rights and content

Summary

Lung cancer survival varies greatly from one European country to another. Differences in data collection may account for some of the variations observed. The aim of this work was to ascertain the survival rate in diverse Spanish regions and to analyse the influence of age and other prognostic factors. This was a prospective, observational, multiregional study carried out in 10 hospitals from 8 different Spanish regions. Epidemiological and clinical data, diagnostic and therapeutic procedures, and 3-year survival were recorded according to a common protocol and uniform criteria in 1027 patients with lung cancer diagnosed in 2003. Thirteen (1.26%) were lost to follow-up. The average 3-year survival rate in the remaining 1014 patients was 13.8% with regional rates varying from 6.7% to 19.7%. The resection rate also varied greatly. Early TNM stage, surgical treatment, and asymptomatic status at diagnosis were good independent prognostic factors. Cardiovascular comorbidity and weight loss had an adverse influence on survival. Patients over the age of 70 years were more often asymptomatic at diagnosis; they had less advanced disease and more comorbidity, received less active treatment and had worse survival. The average long-term survival rate in this Spanish series was similar to that reported for other European countries. It varied widely between regions depending on the resection rate. We conclude that although older patients are diagnosed at less advanced stages of disease, they have worse survival because they are less likely to receive effective therapy.

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.

References (21)

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