Prognostic factors for survival of stage I nonsmall cell lung cancer patients§

A population-based analysis of 19,702 stage I patients in the California Cancer Registry from 1989 to 2003

Authors

  • S.-H. Ignatius Ou MD, PhD,

    Corresponding author
    1. Division of Hematology/Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, Orange, California
    2. Genetic Epidemiology Research Institute, School of Medicine, University of California-Irvine, Irvine, California
    3. Department of Epidemiology, School of Medicine, University of California-Irvine, Irvine California
    • Division of Hematology/Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, 101 The City Drive South, Building 56, Room 241, RT 81, Orange, CA 92868-3298
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    • Fax: (714) 456-2242

  • Jason A. Zell DO, MPH,

    1. Division of Hematology/Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, Orange, California
    2. Genetic Epidemiology Research Institute, School of Medicine, University of California-Irvine, Irvine, California
    3. Department of Epidemiology, School of Medicine, University of California-Irvine, Irvine California
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  • Argyrios Ziogas PhD,

    1. Genetic Epidemiology Research Institute, School of Medicine, University of California-Irvine, Irvine, California
    2. Department of Epidemiology, School of Medicine, University of California-Irvine, Irvine California
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  • Hoda Anton-Culver PhD

    1. Genetic Epidemiology Research Institute, School of Medicine, University of California-Irvine, Irvine, California
    2. Department of Epidemiology, School of Medicine, University of California-Irvine, Irvine California
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  • The collection of cancer incidence data used in this study under subcontract 050N-8707-S1527 with the Public Health Institute, State of California, was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Sections 103875 and 103885; the National Cancer Institute's Surveillance, Epidemiology, and End Results Program; the Centers for Disease Control and Prevention National Program of Cancer Registries.

  • The ideas and opinions expressed herein are those of the authors, and endorsement by the State of California, Department of Health Services, the National Cancer Institute, the Centers for Disease Control and Prevention, and/or the Genetic Epidemiology Research Institute of the University of California-Irvine is not intended nor should be inferred.

  • §

    Presented in part at the 43rd annual meeting of the American Society of Clinical Oncology, Chicago, Illinois, June 1–6, 2007.

Abstract

BACKGROUND.

Platinum-based adjuvant chemotherapy in randomized trials has failed to provide a survival benefit in patients with resected stage I nonsmall cell lung cancer (NSCLC). Using data from the California Cancer Registry (CCR), we explored factors that had detrimental effects on survival in patients with stage I NSCLC to identify a subset of patients at high risk for disease recurrence and subsequent mortality.

METHODS.

Between 1989 and 2003, 19,702 incident cases of stage I NSCLC in the CCR were identified and subgrouped into stage IA and IB disease. Patient demographic factors, tumor characteristics, and treatment delivered were examined. Kaplan-Meier survival curves were calculated to estimate survival rates. Cox proportional-hazards ratios were used to identify independent prognostic factors for survival.

RESULTS.

Advanced age at diagnosis, male sex, low socioeconomic status (SES), nonsurgical treatment, and poor histologic grade (stage IA NSCLC: hazards ratio [HR], 1.13; 95% confidence interval [95% CI], 1.08–1.19; stage IB NSCLC: HR, 1.11; 95% CI, 1.07–1.16) were associated with increased mortality risk on multivariate analysis. Nonupper lobe tumor location (right middle lobe, right and left lower lobes) and tumor size ≥4 cm (vs <4 cm: HR, 1.23; 95% CI, 1.15–1.30) were additional factors that increased the risk of mortality among patients with stage IB disease. Bronchioloalveolar carcinoma and Asian ethnicity were associated with decreased mortality risk in stage I NSCLC.

CONCLUSIONS.

Stage I NSCLC with poorly differentiated histology and stage IB NSCLC with nonupper lobar tumor location or tumor size ≥4 cm carried an increased mortality risk. Cancer 2007. © 2007 American Cancer Society.

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