| Introduction:In recent years,breakthroughs have been made in lung cancer treatment.But there are few studies on changes in lung cancer patients’ survival rate at the population level.The impact of treatment progress on the survival rate of the patient population is still unclear.This study aims to explore the trends in the survival rate of patients with non-small cell lung cancer and small cell lung cancer over time.This study explored the survival of the patient population by comparing the trends in the one-year survival rate of the patient population with breakthroughs in the field of lung cancer treatment.The survival advantage of radiotherapy for patients with advanced non-small cell lung cancer and extensive-disease small-cell lung cancer has not been adequately evaluated.This study explored the effects of radiotherapy in different subgroups,especially in patients with advanced non-small cell lung cancer and extensive-disease small-cell lung cancer with different metastases.Materials and methods:The data used in this research comes from the Surveillance,Epidemiology,and End Results(SEER)database.The research on the change trend of lung cancer survival rate uses the information of lung cancer patients diagnosed from 1975 to 2016 in the SEER database.Joinpoint software was used to assess trends in the 1-and 2-year survival rates.We further performed age-period-cohort analyses to elucidate underlying factors behind the observed temporal trends.We used stacked area charts to illustrate yearly changes in the percentage of different staging and treatment modes changed by year and are also described using stacked area charts.To investigate the role of radiotherapy in patients with advanced lung cancer,we analyzed advanced lung cancer patients from the SEER registry through January 2010 to December 2016.Propensity score analysis with 1:1 nearest neighbor matching method was used to ensure well-balanced characteristics of all comparison groups by histological types and metastatic sites.Kaplan-Meier and Cox proportional hazardous model were used to evaluate the overall survival and corresponding 95%confidence interval(95%CI).Results:For small-cell lung cancer,the 1-year survival plateaued in 1991 following continuous improvement that began in 1975.Conversely,for non-small-cell lung cancer,the 1-year survival continuously improved since 1975.The 1-year survival of non-small-cell lung cancer among women gradually increased,by 0.7%(P<0.001)annually from 1975 through 2003 and by 1.7%(P<0.001)annually from 2003 through 2016.In men,however,this survival rapidly began to improve in 2012,by 3.8%(P<0.001)per year.The observed period and cohort effects in the survival increase indicated continuous improvements over the years and generations for most non-small-cell lung cancer subgroups.In non-small cell lung cancer and small cell lung cancer,the proportion of unknown stage decreased from 27.9%and 27.1%in 1988 to 3.3%and 1.9%in 2017;the proportion of stage Ⅳ disease increased,from 31.7%and 48.9%in 1988 to 43.9%and 66.9%in 2017,respectively.Over the years,more and more lung cancer patients at various stages have received radiotherapy.1-year survival rates significantly increased across all stages in non-small cell lung cancer patients,from 80,36,and 14%in 1988 to 91,65,and 32%in 2016 for stage Ⅰ-Ⅱ,stage Ⅲ,and stage Ⅳ,respectively(P<0.05).In small-cell lung cancer,the 1-year survival rates for stageⅢ and stage Ⅳ patients significantly increased from 41 and 18%in 1988 to 52 and 23%in 2016(P<0.05),plateaued at approximately 70%for stage Ⅰ-Ⅱ patients(P=0.976).Generally speaking,there was a trend toward improved overall survival for using radiotherapy to advanced lung cancer patients.Radiotherapy significantly improved the survival of non-small cell lung cancer patients with metastasis to brain(P<0.001),especially for adenocarcinoma(P<0.001).For stage Ⅳ lung cancer patients with squamous cell carcinoma,radiotherapy for any metastatic sites,except for liver metastases,could universally improve the overall survival(P<0.001).For all metastatic extensive-disease small-cell lung cancer,receiving radiotherapy was associated with improved overall survivals.Conclusion:Our findings reveal the changes in lung cancer survival trends over the past four decades.The 1-year survival rate of lung cancer is influenced by both period and cohort effects.Specifically,the 1-year survival rate of non-small cell lung cancer patients has gradually and continuously increased since 1975,with the best improvement observed in male patients from 2012 following approval of epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs).In addition,more and more radiotherapy modalities have been applied for treatment of lung cancer patients,at various stages,a trend that was consistently correlated with improved survival rates.The results support that radiotherapy in addition to chemotherapy might improve the survival of patients with metastatic lung cancer.It is prudent to carefully select patients for radiotherapy in metastatic non-small cell lung cancer. |
PDF Full Text Request