ABSTRACT
BACKGROUND: The impact of the most recent advances, including targeted therapies and immune checkpoint inhibitors, on early (3-month) mortality in lung cancer is unknown. The aims of this study were to evaluate the real-world rate of and risk factors for early mortality, as well as trends in early mortality over the last 20 years. MATERIALS AND METHODS: The KBP prospective observational multicenter studies have been conducted every 10 years since 2000. These studies collect data on all newly diagnosed patients with lung cancer (all stages and histologies) over 1 year in non-academic public hospital pulmonology or oncology units in France. In this study, we analyzed data on patient and tumor characteristics from participants in the KBP-2020 cohort and compared the characteristics of patients who died within 3 months of diagnosis with those of all other patients within the cohort. We also carried out a comparative analysis with the KBP-2000 and KBP-2010 cohorts. RESULTS: Overall, 8999 patients from 82 centers were included in the KBP-2020 cohort. Three-month survival data were available for 8827 patients, of whom 1792 (20.3%) had died. Risk factors for early mortality were: male sex, age >70 years, symptomatic disease at diagnosis, ever smoker, weight loss >10 kg, poor Eastern Cooperative Oncology Group performance status (≥1), large-cell carcinoma or not otherwise specified, and stage ≥IIIC disease. The overall 3-month mortality rate was found to have decreased significantly over the last 20 years, from 24.7% in KBP-2000 to 23.4% in KBP-2010 and 20.3% in KBP-2020 (P < 0.0001). CONCLUSION: Early mortality among patients with lung cancer has significantly decreased over the last 20 years which may reflect recent improvements in treatments. However, early mortality remained extremely high in 2020, particularly when viewed in light of improvements in longer-term survival. Delays in lung cancer diagnosis and management could contribute to this finding.
Subject(s)
Lung Neoplasms , Humans , Lung Neoplasms/mortality , Male , Female , France/epidemiology , Aged , Risk Factors , Middle Aged , Prospective Studies , Aged, 80 and overABSTRACT
OBJECTIVE: To estimate five-year survival in non-small-cell lung cancer (NSCLC) patients according to histology and to identify independent prognostic factors by histology. METHODS: Data were obtained during the KBP-2010-CPHG study, which included all new cases of primary lung cancer diagnosed in 2010 in 104 non-academic hospitals. RESULTS: In all, 3199 patients had adenocarcinoma (ADC), 1852 squamous cell carcinoma (SCC), 754 large cell carcinoma (LCC). Five-year survival was 13.3% [12.1%-14.5%] for ADC, 14.3% [12.7%-16.0%] for SCC, 9.6% [7.6%-11.9%] for LCC (P<0.001). Performance status, weight loss prior to diagnosis and tumour stage were consistently significant independent prognostic factors. Age (>70 years; P=0.004), male gender (P<0.001), and smoking (P<0.001) were independent negative prognostic factors for ADC. Epidermal Growth Factor Receptor (EGFR)-mutation tests, performed in 1638 ADC patients, were positive for 186. Five-year survival was 14.7% [10.3%-21%] and 10.9% [9.4%-12.6%] for mutated and wild-type EGFR, respectively (P<0.001). EFGR mutation was an independent positive prognostic factor (HR=0.5 [0.4-0.6], P<0.001); however, the proportional hazards assumption was not fulfilled and hazards were inverted after 35 months. CONCLUSIONS: Five-year survival in patients managed in French non-academic hospitals for primary NSCLC in 2010 remained poor (<15%), whatever the histologic type. The independent negative prognostic factors for five-year survival were: weight, particularly weight loss prior to diagnosis; smoking (active or former) at diagnosis in ADC and LCC and smoking level at diagnosis in smoker patients with SCC. The independent positive prognostic factors were young age and female gender for ADC.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/mortality , Lung Neoplasms/diagnosis , Lung Neoplasms/mortality , Adenocarcinoma/diagnosis , Adenocarcinoma/genetics , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Aged , Biopsy , Carcinoma, Large Cell/diagnosis , Carcinoma, Large Cell/genetics , Carcinoma, Large Cell/mortality , Carcinoma, Large Cell/pathology , Carcinoma, Non-Small-Cell Lung/genetics , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/genetics , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , ErbB Receptors/genetics , Female , France/epidemiology , Humans , Lung Neoplasms/genetics , Lung Neoplasms/pathology , Male , Middle Aged , Mutation , Neoplasm Staging , Prognosis , Survival AnalysisABSTRACT
Chronic respiratory diseases (C.R.D.) induce changes in daily activities and mood for the patients who require respiratory assistance (oxygen delivery or ventilation). The aim of this study was to compare physical and social consequences of this disease. A self administered questionnaire was sent to one hundred patients, over sixty five years of age, who were affiliated with the "Association Limousine d'Aide aux Insuffisants Respiratories" (A.L.A.I.R.). The mean age was 72.4 +/- 0.66 (65-92), the mean PaO2 was 54 mm Hg +/- 0.2 (39-76). C.R.D. was stable during the study and treatments did not change. The questionnaire was composed of four scales and twenty-eight subjects; each item was weighed for importance. Subjects included: symptoms, mood, sleep, relationships with their wife or family, home activities. Eighty-five questionnaires were analysed. Reproductibility was good (92%) and non-responses to some questions was less than 10%. Coherence between the scales and the twenty-eight items was poor. Regression linear analysis found that only dyspnea was correlated with PaO2 (p < 0.007). For patients, the most important items were: abnormalities of home activities (37%), dyspnea (38%), relationships with their wife (39%) or family (45%), dependence (52%) and perception of A.L.A.I.R. (77%). Quality of life is an important concept for these patients with C.R.D. versus clinical symptoms. Perception of respiratory assistance is very good.
Subject(s)
Activities of Daily Living , Home Care Services , Respiratory Insufficiency/psychology , Aged , Chronic Disease , Family , Female , Humans , Male , Oxygen Inhalation Therapy , Quality of Life , Respiratory Insufficiency/complications , Respiratory Insufficiency/therapy , Respiratory Therapy , Surveys and QuestionnairesABSTRACT
The authors report a case of pulmonary metastasis which exceptionally occurred 19 years after hysterectomy for uterine choriocarcinoma. They use this opportunity to take stock of our present knowledge concerning this subject by reviewing a vast literature. This case is of interest, as it provides a new element to the theoretical study of carcinogenesis.