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. 2021 Dec 1;7(12):1824-1832.
doi: 10.1001/jamaoncol.2021.4932.

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

Apar Kishor Ganti  1   2 , Alyssa B Klein  3 , Ion Cotarla  3 , Brian Seal  3 , Engels Chou  3
Affiliations

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

Apar Kishor Ganti et al. JAMA Oncol. .

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% ≥ 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 ≥65 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 relevance: The 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Ganti is a consultant for AstraZeneca, Genentech, and Flagship Biosciences, has served on advisory boards for AstraZeneca, Blueprint Medicines, Jazz Pharmaceuticals, Cardinal Health, Mirati Therapeutics, and G1 Therapeutics, and receives research support from Takeda and Oncoceutics. Ms Klein, Dr Seal, and Ms Chou are former employees of AstraZeneca and were employees of and shareholders in AstraZeneca at the time of the study. Dr Cotarla is an employee of and shareholder in AstraZeneca.

Figures

Figure 1.
Figure 1.. Distribution of Lung Cancer by Histologic Findings and Distribution of NSCLC by Stage, Age, and Year
NOS indicates not otherwise specified; NSCLC, non–small cell lung cancer; SEER-18, Surveillance, Epidemiology, and End Results; NPCR, National Program of Cancer Registries. A, Distribution of lung cancer by histologic findings (SEER-NPCR, 2010-2017 overall). B, Distribution of lung cancer by histologic findings (SEER-18, 2010-2017 overall). C, NSCLC stage by histologic findings, overall and by age (SEER-18, 2017). D, Distribution of NSCLC stage by year (SEER-18, 2010-2017).
Figure 2.
Figure 2.. Annual Incidence of NSCLC (2010-2017) Overall and by Age and Stage
NSCLC indicates non–small cell lung cancer; SEER-18, Surveillance, Epidemiology, and End Results; NPCR, National Program of Cancer Registries. A, NSCLC incidence overall and by age (SEER-NPCR; SEER-18). B, Overall incidence by stage (nationwide projection of SEER-18). C, Incidence among those younger than 65 years by age and stage (nationwide projection of SEER-18). D, Incidence among those aged 65 years or older by stage (nationwide projection of SEER-18). Maximum values of vertical axes vary based on range of data shown. Overall incidence data (ie, not broken out by stage) are from SEER-NPCR and SEER-18. All other data are SEER-18 projected to a national level.
Figure 3.
Figure 3.. Annual Prevalence of NSCLC (2010-2016, Nationwide Projection of SEER-18) Overall and by Age
NSCLC indicates non–small cell lung cancer; SEER-18, Surveillance, Epidemiology, and End Results. Prevalence data are from SEER-18 projected to a national level.
Figure 4.
Figure 4.. Distribution of Initial Treatment by NSCLC Stage (SEER-18, 2016)
NSCLC indicates non–small cell lung cancer; SEER-18, Surveillance, Epidemiology, and End Results. A, for all ages; B, for those younger than 65 years; and C, those aged 65 years or older. Multiple treatments (other) indicates various combinations of chemotherapy, radiation, and/or surgery (excluding chemotherapy + radiation).
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Comment in

  • The Long, Slow Road to Lung Cancer Cure.
    Mulshine JL, Pyenson B. Mulshine JL, et al. JAMA Oncol. 2021 Dec 1;7(12):1765-1767. doi: 10.1001/jamaoncol.2021.4711. JAMA Oncol. 2021. PMID: 34673896 No abstract available.

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