Persistent increase and improved survival of stage I lung cancer based on a large-scale real-world sample of 26,226 cases

Background:Lung cancer prevails and induces high mortality around the world.This study provided real-world information on the evolution of clinicopathological profiles and survival outcomes of lung cancer,and provided survival information within stage I subtypes.Methods:Patients pathologically confirmed with lung cancer between January 2009 and December 2018 were identified with complete clinicopathological information,molecular testing results,and follow-up data.Shifts in clinical characteristics were evaluated usingχ^(2)tests.Overall survival(OS)was calculated through the Kaplan-Meier method.Results:A total of 26,226 eligible lung cancer patients were included,among whom 62.55%were male and 52.89%were smokers.Non-smokers and elderly patients took increasingly larger proportions in the whole patient population.The proportion of adenocarcinoma increased from 51.63%to 71.80%,while that of squamous carcinoma decreased from 28.43%to 17.60%.Gene mutations including EGFR(52.14%),KRAS(12.14%),and ALK(8.12%)were observed.Female,younger,non-smoking,adenocarcinoma patients and those with mutated EGFR had better survival prognoses.Importantly,this study validated that early detection of early-stage lung cancer patients had contributed to pronounced survival benefits during the decade.Patients with stage I lung cancer,accounted for an increasingly considerable proportion,increasing from 15.28%to 40.25%,coinciding with the surgery rate increasing from 38.14%to 54.25%.Overall,period survival analyses found that 42.69%of patients survived 5 years,and stage I patients had a 5-year OS of 84.20%.Compared with that in 2009-2013,the prognosis of stage I patients in 2014-2018 was dramatically better,with 5-year OS increasing from 73.26%to 87.68%.Regarding the specific survival benefits among stage I patients,the 5-year survival rates were 95.28%,93.25%,82.08%,and 74.50%for stage IA1,IA2,IA3,and IB,respectively,far more promising than previous reports.Conclusions:Crucial clinical and pathological changes have been observed in the past decade.Notably,the increased incidence of stage I lung cancer coincided with an improved prognosis,indicating actual benefits of early detection and management of lung cancer.