Update of Incidence, Prevalence, Survival, and Initial Treatment in Patients With Non–Small Cell Lung Cancer in the US

Abstract

IMPORTANCE Updated estimates of non-small cell lung cancer (NSCLC) in the US are needed. OBJECTIVE To calculate the most recent epidemiologic estimates of NSCLC in the US. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional epidemiological analysis used the most recently released data from US cancer registries. The population-based US Cancer Statistics (USCS) database (2010-2017), comprised of the Surveillance, Epidemiology, and End Results (SEER) program and the National Program of Cancer Registries (NPCR) (collectively, SEER-NPCR) provided the NSCLC incidence estimate. The SEER-18 database provided data for incidence, prevalence, survival, and initial treatment by NSCLC stage. Adults aged 18 years or older diagnosed with NSCLC identified by International Classification of Diseases for Oncology, Third Edition, morphology codes were included.MAIN OUTCOMES AND MEASURES Annual age-adjusted NSCLC incidence per 100 000 persons; annual prevalence per 100 000 persons; survival rate; initial treatment. Due to database release delays, incidence data were available through 2017, and other parameters through 2016. The analysis was conducted from June 2020 to July 2020. RESULTS There were 1.28 million new NSCLC cases recorded during 2010 to 2017 in the US (SEER-NPCR: 53% male; 67% Ն 65 years). From 2010 to 2017, NSCLC incidence per 100 000 decreased from 46.4 to 40.9 overall (age <65 years: 15.5 to 13.5; age Ն65 years: 259.9 to 230.0); the incidence of stage II, IIIA, and IIIB NSCLC was stable, and stage IV decreased slightly from 21.7 to 19.6, whereas stage I incidence increased from 10.8 to 13.2. From 2010 to 2016, NSCLC prevalence per 100 000 increased from 175.3 to 198.3 (nationwide projection of SEER-18); prevalence increased among younger patients (77.5 to 87.9) but decreased among older patients (825.1 to 812.4). Period survival analysis found that 26.4% of patients survived 5 years, which is higher than previously reported. The proportion of stage I NSCLC treated with radiation as single initial treatment rose markedly from 14.7% in 2010 to 25.7% in 2016. Patients with stage IV NSCLC aged 65 years or older were most likely to be untreated (38.3%). CONCLUSIONS AND RELEVANCEThe findings of this cross-sectional epidemiological analysis suggest that the increased incidence of stage I NSCLC at diagnosis likely reflected improved evaluation of incidental nodules. A smaller proportion of patients aged 65 years or older with stage IV NSCLC were treated. Earlier detection and availability of effective treatments may underlie increased overall NSCLC prevalence, and higher than previously reported survival.

Association of computed tomography screening with lung cancer stage shift and survival in the United States: quasi-experimental study

“…Of note, two previous studies using the SEER Program database have reported that recent increases in the incidence of stage I NSCLC diagnosed contributed to improvements in lung cancer survival. 20 21 These studies similarly suggested that these trends may be explained, in part, by increases in the early detection of lung cancer through screening. Our analysis differed from these studies in that we focused on evaluating patients aged 55-80 (patients potentially eligible for screening on the basis of age) and we used the NCDB to evaluate whether the rate of increase in stage I disease was significantly greater after the USPSTF recommended screening than it was before.…”

Is it time to move on to the next generation of clinical trials in older patients with cancer?

“…Lung cancer is the leading cause of cancer death worldwide and is commonly diagnosed in older patients, with the median age of diagnosis in the UK being 71 years (IQR 62-75). 1 Treatment rates, both curative and palliative in intent, decrease with age, 2 the reasons for which are complex and might include complications in treatment delivery due to comorbidities, poor functional status, and frailty, which are common in older people. These problems might be more marked in squamous-cell lung cancer, which accounts for 25% of cases of non-small-cell lung cancer (NSCLC), as this type of lung cancer commonly arises in patients who are currently or have previously been smokers and might be associated with smoking-related diseases such as chronic obstructive pulmonary disease, ischaemic heart disease, and peripheral vascular disease.…”

Neoadjuvant immunotherapy followed by surgery with curative intent in 35 patients with advanced NSCLC: the retrospective experiences of a multidisciplinary team

“…Lung cancer is one of the most common malignancies worldwide, and approximately one-third of cases of nonsmall cell lung cancer (NSCLC) are locally advanced at the time of diagnosis (1). Platinum-based chemotherapy is routinely used to treat advanced or metastatic NSCLC.…”