Patterns of survival and surgical treatment in lung cancer patients in Estonia by histologic type and stage, 1996–2016

Abstract

Background: Lung cancer (LC) remains the most frequent cause of cancer death worldwide. We aimed to examine long-term trends in LC survival in Estonia by age, gender, histologic type and stage, with specific focus on surgical treatment. Material and methods: Data on all incident cases of LC diagnosed from 1996 to 2016 were obtained from the Estonian Cancer Registry. Logistic regression was used to examine receipt of surgical treatment in localized LC. Relative survival ratios (RSR) were calculated, and excess hazard ratios (EHR) of death were estimated by stage with gender, age, histology and period of diagnosis as independent variables. Results: Among the total of 16,423 cases, squamous cell carcinoma remained the most common histologic type. The odds of receiving surgical treatment in localized LC increased significantly over time and were associated with age, gender and histologic type. Overall, the age-standardized 5-year RSR improved significantly from 10% in 1996-2002 to 16% in 2010-2016 (from 8% to 15% in men and from 15% to 20% in women). Larger survival gain was seen in younger patients, for non-small cell LC subtypes, and for surgically treated patients. For localized disease, the 5-year RSR increased by more than 20 percentage units, reaching 50% in men and 69% in women. For all stages, the adjusted EHR of death was significantly associated with age, histologic type and period of diagnosis. Conclusions: We observed a substantial improvement of relative survival, with considerable variations across patient groups. After adjustment for age, gender and histology, a significant survival increase over time was seen for all stages. The considerable survival gain observed for localized LC can largely be attributed to rapidly growing proportion of surgically treated patients. Further investigation of LC management practices, particularly the use of non-surgical treatment options is warranted.

Cancer registration in the era of modern oncology and GDPR

“…A similar improvement can be seen in Norwegian rates [4]. The Estonians report an increase in T1 tumors from 2010 to 2016 from 27% to 47%, possibly due to the occasional finding on a CT ordered for other purposes [3]. This is quite a substantial change.…”

“…Results from the Nordic countries are displayed in the Nordic database NORDCAN [2], a collaboration between the five Nordic countries (http://www-dep.iarc.fr/NORDCAN/english/frame.asp). A recent study from Estonia is another example of a strong cancer registry with a long history [3]. Their registry is more than 40 years old, with cancer reporting going back even further, to 1968 (https://www.tai.ee/en/ r-and-d/registers/estonian-cancer-registry).…”

“…The Estonian study shows that 5-year relative survival of lung cancer diagnosed at a localized stage is currently above 50% in men and 60% in Estonia [3]. This is a remarkable improvement over the past decades.…”

MicroRNA‑564 inhibits the progression of non‑small cell lung cancer via targeting plexin A4

“…Non-small cell lung cancer (NSCLC) accounts for >80% of all lung cancer cases, and tops the list of the most commonly diagnosed type of cancer (1). Although great progress has been achieved in NSCLC therapy, the 5-year overall survival rate has remained unchanged at <16% (2). Due to the poor prognosis, the development of novel strategies for the diagnosis and therapy of NSCLC is urgently required.…”

Intensity of end-of-life health care and 30-day mortality after systemic anti-cancer treatment in patients with advanced lung cancer

“…In Estonia, approximately 800 people annually are newly diagnosed with lung cancer [10]. In the current study, we aimed to characterise EOL care, health care intensity in the final 30 days of life and SACT-related mortality with an emphasis on infectious complications in patients with advanced stage lung cancer based on routine clinical data from the North Estonia Medical Centre's Thoracic Oncology Database.…”