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Trends in Stage I Lung Cancer

Published:November 20, 2022DOI:https://doi.org/10.1016/j.cllc.2022.11.005

      Trends in Stage I Lung Cancer Highlights

      • The percentage of patients diagnosed with stage I lung cancer is increasing
      • This trend is observed in non-small cell lung cancer but not in small cell lung cancer
      • The staging shift may be due to lung cancer screening and a higher detection of incidental lung nodules
      • There are significant imbalances in the percentages of stage I lung cancer according to demographic characteristics

      Abstract

      Introduction: The American Cancer Society has recently reported an increase in the percentage of patients with localized lung cancer from 2004 to 2018, coinciding with the initial lung cancer screening guidelines issued in 2013. We conducted a National Cancer Database (NCDB) study to further evaluate the trends in stage I according to patient and tumor characteristics.
      Methods: We selected patients with lung cancer from the NCDB Public Benchmark Report diagnosed between 2010 and 2017. Patients with stage I to IV according to the AJCC 7th edition were evaluated according to year of diagnosis, histology, age, sex, race, and insurance.
      Results: Among the 1,447,470 patients identified in the database, 56,382 (3.9%) were excluded due to stage 0 or unknown, or incorrect histology, leaving 1,391,088 patients eligible. The percentage of patients with stage I increased from 23.5% in 2010 to 29.1% in 2017 for all lung cancers, from 25.9% to 31.8% in non-small cell lung cancer (NSCLC) and from 5.0% to 5.4% in small cell lung cancer (SCLC). Patients younger than 70 years, males and blacks had lower percentages of stage I compared to older patients, females and non-blacks respectively. Patients with no insurance had the lowest percentage of stage I.
      Conclusions: There has been a significant increase in the percentage of stage I lung cancer at diagnosis from 2010 to 2017, which occurred mostly in NSCLC. Although the staging shift was observed in all subsets of patients, there were noticeable imbalances according to demographic factors.
      Micro-abstract: Recent studies have shown an increase in the percentage of patients with early stage lung cancer. Using the National Cancer Database, we confirmed the staging shift with increased percentage of stage I among patients with non-small cell lung cancer but not for those with small cell lung cancer. Although the increased in the percentage of stage I was observed in all subsets of patients, there were noticeable imbalances according to age, sex, race and insurance status.

      Keywords

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