Rosemary D Cress DrPH Amy K Klapheke MPH PhD Public Health Institute Cancer Registry of Greater California Introduction Lung cancer incidence in California has declined steadily thanks to reduction in smoking ID: 1041126
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1. Trends in survival from metastatic lung cancer in California, 1990-2014 Rosemary D. Cress, DrPHAmy K. Klapheke, MPH, PhDPublic Health InstituteCancer Registry of Greater California
2. IntroductionLung cancer incidence in California has declined steadily thanks to reduction in smokingBut lung cancer remains the leading cause of cancer death.Most patients are diagnosed after the cancer has spread, and prognosis is poor.However recent improvements in treatment for metastatic lung cancer have improved survival for some patients.
3. PurposeThe purpose of this study was to evaluate trends in survival by gender, race/ethnicity, and histologic type for patients diagnosed with metastatic lung cancer in California.
4. MethodsThrough the California Cancer Registry, we identified patients diagnosed with a first primary lung cancer diagnosed at remote/distant (metastatic) stage between 1990 and 2014 with follow up through December 2015. Race/ethnicity was categorized into non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, and Asian/Pacific Islander (API). Histologic subtype was categorized into small cell lung cancer (SCLC), squamous cell carcinoma (SCC), adenocarcinoma, large-cell carcinoma (LCC), non-small cell lung cancer, not otherwise specified (NSCLC, NOS), and other/unknown.
5. Statistical analysisOne-year relative survival was calculated overall and by age at diagnosis, sex, race/ethnicity, and histology for each year in the study period. Joinpoint Regression was used to evaluate trends and to calculate the estimated annual percentage rate change (APC).
6. ResultsA total of 186,156 adults with metastatic lung cancer were identified for analysis.
7. Characteristics of patients with metastatic lung cancer, 1990-2014, CaliforniaN%Age at Diagnosis 20-54 years66,98236.0% 65-74 years60,75432.6% 75+ years58,42031.4%Sex Male103,01355.3% Female83,14344.7%Race/Ethnicity Non-Hispanic White132,76571.3% Non-Hispanic Black15,3098.2% Hispanic18,71910.1% Asian/Pacific Islander18,3949.9% Other/Unknown9690.5%
8. Characteristics of patients with metastatic lung cancer, 1990-2014, California (cont.)Histology Type Small Cell Carcinoma31,64817.0% Squamous Cell Carcinoma26,03314.0% Adenocarcinoma68,68736.9% Large Cell Carcinoma8,2354.4% NSCLC, NOS44,07523.7% Other/Unknown7,4784.0%Year of Diagnosis 1990-199434,84318.7% 1995-199936,56319.6% 2000-200439,45521.2% 2005-200939,25321.1% 2010-201436,04219.4%
9. Relative Survival of Patients with Metastatic Lung Cancer, 1990-2014 , California
10. Annual percent change in 1-year relative survival, by time period and age, 1990-2014, CaliforniaAPC95% CIp-valueOverall^1990-1993-0.69-4.222.980.691993-20122.602.412.79<0.01*2012-2014-0.70-5.994.880.79Age at Diagnosis20-64 years2.512.312.71<0.01*65-74 years2.632.402.87<0.01*75+ years2.742.403.08<0.01*
11. Annual percent change in 1-year relative survival, by gender and race, 1990-2014, CaliforniaSexMale2.121.882.35<0.01*Female^1990-19960.85-0.572.290.231996-20112.962.663.26<0.01*2011-20140.17-2.392.800.89Race/ethnicity NHW1.911.772.06<0.01* NHB2.051.632.48<0.01* Hispanic^ 1990-1995-2.69-9.524.660.44 1995-20142.922.153.68<0.01* API3.282.843.72<0.01*
12. Annual percent change in 1-year relative survival, by histologic type, 1990-2014, CaliforniaHistology Small-Cell0.04-0.260.330.79 Squamous1.310.951.66<0.01* Adenocarcinoma^ 1990-20093.903.594.21<0.01* 2009-20141.17-0.372.740.13 Large Cell2.311.553.06<0.01* NSCLC NOS^ 1990-20063.322.833.81<0.01* 2006-2014-0.88-2.170.440.18 Other-1.04-1.90-0.190.02*
13. Summary of resultsSurvival for patients with metastatic lung cancer improved over the past 25 years. One-year survival increased from 18.4%-29.4%Improvement was seen in almost all groups, but was particularly pronounced for women (19.9%-33.3%), for API’s (26.0%-43.6%) and for those with adenocarcinoma (18.4%-38.2%).We also observed increases in five-year survival for patients diagnosed 1988-2010, from 2.2%-5.0%.
14. ConclusionsWhile long term survival for patients with metastatic lung cancer continues to be very poor, one year survival has improved over the past twenty-five years.This likely reflects improvements in treatment for these patients, in particular specific chemotherapy and molecularly targeted therapies.
15. AcknowledgementsTianhong Li, MD, PhDAssociate professorDivision of Hematology & Oncology, Department of Internal Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
16. Questions?Contact:Rosemary D. Cress, DrPHResearch Program Director, SEER Principal InvestigatorPublic Health Institute, Cancer Registry of Greater Californiarcress@crgc-cancer.org