Survival and prognostic factors of early‐stage non‐small cell lung cancer in Central and Eastern Europe: A prospective cohort study

Abstract

Background Although early diagnosis and surgical resection of the tumor have been shown to be the most important predictors of lung cancer survival, long‐term survival for surgically‐resected early‐stage lung cancer remains poor. Aims In this prospective study we aimed to investigate the survival and prognostic factors of surgically‐resected early‐stage non‐small cell lung cancer (NSCLC) in Central and Eastern Europe. Methods We recruited 2052 patients with stage I‐IIIA NSCLC from 9 centers in Russia, Poland, Serbia, Czech Republic, and Romania, between 2007–2016 and followed them annually through 2020. Results During follow‐up, there were 1121 deaths (including 730 cancer‐specific deaths). Median survival time was 4.9 years, and the 5‐year overall survival was 49.5%. In the multivariable model, mortality was increased among older individuals (HR for each 10‐year increase: 1.31 [95% CI: 1.21–1.42]), males (HR:1.24 [1.04–1.49]), participants with significant weight loss (HR:1.25 [1.03–1.52]), current smokers (HR:1.30 [1.04–1.62]), alcohol drinkers (HR:1.22 [1.03–1.44]), and those with higher stage tumors (HR stage IIIA vs. I: 5.54 [4.10 – 7.48]). However, education, chronic obstructive pulmonary diseases (COPD), and tumor histology were not associated with risk of death. All baseline indicators of smoking and alcohol drinking showed a dose‐dependent association with the risk of cancer‐specific mortality. This included pack‐years of cigarettes smoked (p‐trend = 0.04), quantity of smoking (p‐trend = 0.008), years of smoking (p‐trend = 0.010), gram‐days of alcohol drank (p‐trend = 0.002), frequency of drinking (p‐trend = 0.006), and years of drinking (p‐trend = 0.016). Conclusion This study shows that the 5‐year survival rate of surgically‐resected stage I‐IIIA NSCLC is still around 50% in Central and Eastern Europe. In addition to non‐modifiable prognostic factors, lifetime patterns of smoking and alcohol drinking affected the risk of death and disease progression in a dose‐dependent manner in this population.

The Nine-Year Survival of Patients Operated for Non-Small-Cell Lung Carcinoma in a Tertiary Centre: The Impact of the Tumour Stage and Other Patient-Related Parameters

“…A study by Mahdi Sheikh and colleagues found that the five-year survival rate of patients with NSCLC who underwent surgery with curative intent is around 50% in Central and Eastern Europe [ 18 ]. This percentage is comparable with the one reported by us.…”

Early-Stage Non-Small Cell Lung Cancer: Prevalence of Actionable Alterations in a Monocentric Consecutive Cohort

“…Surgery is the main modality of treatment and, until recently, the post-operative standard of care was represented by a platinum-based twodrug combination chemotherapy [8]. However, long-term survival for surgically resected tumors remains poor, equal to 5.4% at 5 years, with an overall survival rate ranging from 90% to 12% in stages I and III, respectively [10][11][12]. To date, stage IB-IIIA resected NSCLC with EGFR exon 19 deletions or exon 21 p.(L858R) mutation can benefit from adjuvant treatment with osimertinib, a third-generation EGFR tyrosine kinase inhibitor (TKI).…”