Incidence and survival of non-small cell lung cancer in Shanghai: a population-based cohort study

Abstract

Objectives: Large population-based studies on the incidence and outcome of non-small cell lung cancer (NSCLC) are lacking in mainland China. This study aimed to investigate the NSCLC incidence, demographic features and survival as well as factors affecting survival of patients with NSCLC in Shanghai.

Design: Prospective observational cohort study.

Setting: Baseline information was collected from Shanghai Health Information Network, which is based on the Health Information Systems from all the comprehensive hospitals and specialist hospitals qualified for cancer diagnosis in the Shanghai metropolitan area.

Participants: All NSCLC cases identified from the database between 2011 and 2013 were recruited (15,020 patients).

Main results: The crude and age-adjusted incidences of NSCLC were 54.20 per 100,000 people (55.90 per 100,000 for men, 52.39 per 100,000 for women) and 39.05 per 100,000 people (41.43 per 100,000 for men and 37.13 per 100,000 for women), respectively. The median survival time was 22.7 months (95% CI 21.8 to 24.2 months) with an overall 1-year survival rate of 71.8% (95% CI 69.8% to 73.8%). The 1-year survival rate was 96.5% (95% CI 94.0% to 98.6%) in patients with stage I NSCLC, 89.1% (95% CI 83.3% to 94.9%) in patients with stage II NSCLC, 78.8% (95% CI 74.1% to 83.5%) in patients with stage IIIa NSCLC and 58.9% (95% CI 56.1% to 61.7%) in patients with stage IIIb/IV NSCLC. Multivariate analysis showed surgical resection (HR=0.607, 95% CI 0.511 to 0.722) and chemotherapy (HR=0.838, 95% CI 0.709 to 0.991) significantly improved survival. Factors associated with poor survival included older age, male sex, larger tumour size, lymph node metastasis, distant metastasis and squamous cell carcinoma.

Conclusions: A higher incidence and better survival rates for patients with NSCLC were identified when compared with previously published studies, which may provide evidence on the incidence and survival of NSCLC in China.

Keywords: CHEMOTHERAPY; SURGERY.

Figure 1

Flow chart of study population and analysis groups (NSCLC, non-small cell lung cancer; TNM, tumour, node and metastasis score).

Figure 2

The overall survival (OS) of patients with non-small cell lung cancer (NSCLC) in Shanghai identified in 2011–2013 (n=2013). A 1-year OS rate: whole population 71.8% (95% CI 69.8% to 73.8%), stage I 96.5% (95% CI 94.0% to 98.6%), stage II 89.1% (95% CI 83.3% to94.9%), stage IIIa 78.8% (95% CI 74.1% to 83.5%) and stage IIIb/IV 58.9% (95% CI 56.1% to 61.7%). The survival difference was significant (p<0.0001).

Figure 3

The overall survival (OS) of non-small cell lung cancer (NSCLC) cases in Shanghai identified in 2011–2013, according to surgery by stage (n=2013). A 1-year OS rate of stage I patients: with surgery 96.3% (95% CI 94.5% to 98.1%), without surgery 100.0%; stage II: with surgery 90.0% (95% CI 84.1% to 95.9%), without surgery 80.0% (95% CI 55.2% to 100.0%); stage IIIa: with surgery 84.3% (95% CI 79.1% to 89.5%), without surgery 68.9% (95% CI 60.0% to 77.8%); stage IIIb/IV: with surgery 73.1% (95% CI 67.2% to 79.0%), without surgery 55.7% (95% CI 52.5% to 58.9%). The survival benefit of surgery was observed among stage IIIa patients (adjusted HR=0.513, 95% CI (0.352 to 0.748) and stage IIIb/IV patients (adjusted HR=0.646, 95% CI 0.536 to 0.779).