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. 2019 Dec 28:2019:8148156.
doi: 10.1155/2019/8148156. eCollection 2019.

Epidemiology and Survival Outcomes of Lung Cancer: A Population-Based Study

Huan-Tang Lin  1   2   3 , Fu-Chao Liu  1   2 , Ching-Yang Wu  2   4 , Chang-Fu Kuo  5   6 , Wen-Ching Lan  7 , Huang-Ping Yu  1   2   8
Affiliations

Epidemiology and Survival Outcomes of Lung Cancer: A Population-Based Study

Huan-Tang Lin et al. Biomed Res Int. .

Abstract

Purpose: Lung cancer has been the top-ranking cause of cancer deaths in Taiwan for decades. Limited data were available in global cancer surveillance regarding lung cancer epidemiology in Taiwan, and previous reports are outdated.

Patients and methods: This population-based cohort study extracted data of patients with lung cancer from the Taiwan National Health Insurance database and determined the lung cancer incidence and prevalence during 2002-2014. Histological subtypes were retrieved from the Taiwan Cancer Registry database; survival rates were gathered from the National Death Registry. Average annual percentage changes (APCs) of prevalence, incidence, and overall survival were estimated by joinpoint regression analysis.

Results: Age-standardized incidence of lung cancer increased from 45.04 per 100,000 person-years in 2002 to 49.86 per 100,000 person-years in 2014, with an average APC of 0.7 (95% CI = 0.3-1.1; 0.2 in males, 2.0 in females). Lung cancer was more prevalent in male patients, but this increase gradually slowed down. Socioeconomic analysis showed that lung cancer has higher prevalence in patients with higher income level and urban residency. Adenocarcinoma was the most abundant histological subtype in Taiwan (adenocarcinoma-to-squamous cell carcinoma ratio = 4.16 in 2014), with a 2.4-fold increase of incident cases during 2002-2014 (from 43.47% to 64.89% of all lung cancer cases). The 5-year survival rate of lung cancer patients in 2010 was 17.34% (12.60% in male, 25.40% in female), with an average APC of 9.3 (6.3 in male, 11.8 in female) during 2002-2010.

Conclusion: Average APCs of prevalence and incidence of lung cancer were 3.1 and 0.7, respectively, during 2002-2014 in Taiwan. The number of female patients and number of patients with adenocarcinoma have increased the most, with incident cases doubling in these years. Facing this fatal malignancy, it is imperative to improve risk stratification, encourage early surveillance, and develop effective therapeutics for lung cancer patients in Taiwan.

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Conflict of interest statement

The authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Geographic variation in the prevalence and incidence of lung cancer in Taiwan in 2002 and 2014. (a) Prevalence in 2002. (b) Incidence in 2002. (c) Prevalence in 2014. (d) Incidence in 2014.
Figure 2
Figure 2
Annual average of Pollutant Standards Index (PSI, μg/m3) in Taiwan by county in 2002 and 2014. Data were obtained from the Taiwan Air Quality Monitoring Network. PSI is calculated by averaging air pollutant concentration collected for the past 24 hours including particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and ozone (O3). PSI >100 is considered to impair health.
Figure 3
Figure 3
Annual average of fine particulate matter exposure (PM2.5, μg/m3) in Taiwan by county in 2005, 2014, and 2018. Data were obtained from the Taiwan Air Quality Monitoring Network. The first nationwide PM2.5 concentration in Taiwan was released since 2005. For counties with several monitoring stations, we selected the monitoring station with the representative county level of air pollution.
Figure 4
Figure 4
Age-specific (a) prevalence and (b) incidence of lung cancer in Taiwan in 2014 (blue: men; red: women).
Figure 5
Figure 5
Sex-specific prevalence of smoking among adults (over 18 years of age) in Taiwan during 2004–2017 (green: total population; blue: male; red: female). (1) Data based on adult smoking behavior survey provided by the Taiwan health promotion administration. (2) Current smokers were defined as those who had smoked more than 100 cigarettes (5 packs) and had smoked within the past 30 days. (3) The adult smoking rate was weighted and standardized according to sex, age, educational level, and geographic region in year 2000.
Figure 6
Figure 6
Secular trends of 1-year, 3-year, and 5-year survival rates of lung cancer in (a) men and (b) women in Taiwan from 2002 to 2014 (blue: 1-year survival rate; red: 3-year survival rate; green: 5-year survival rate).
Figure 7
Figure 7
Percentage of different histological subtypes of lung cancer in Taiwan in (a) 2002 and (b) 2014 (red: adenocarcinoma; gray: squamous cell carcinoma; blue: other types of lung cancer; yellow: small cell carcinoma; green: large cell carcinoma).
Figure 8
Figure 8
Secular trends of 3-year survival rate in patients with different subtypes of lung cancer (orange: large cell carcinoma; red: adenocarcinoma; blue: squamous cell carcinoma; green: other types of lung cancer; gray: small cell carcinoma).
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