A study of trends and survival with special reference to surgical treatment

We reviewed 3285 consecutive cases of lung cancer diagnosed in West Sweden during the period 196- 1985. Data were collected from the regional cancer registry, the Swedish National Population Registry, and medical records. During the study period, the annual femalehale ratio increased from 0.29 to 0.42. In females, there was an increase primarily in the incidence of tobacco-related morphologic tumour types (i.e. squamous and small cell lung cancers). In males, a moderate increase of adenocarcinomas was seen, although squamous cell cancer remained the most common tumour type. The overall 5-year survival rate was 8.3%. In 641 patients (20%) a surgical tumour resection was carried out. The 5-year survival rate following resection was 38%, and the probability of 10-year survival was estimated at 25%. In a multifactorial model including gender, age, histology, pTNM stage and extent of resection, pTNM stage and, to a lesser degree, age were statistically significant independent predictors of postoperative survival. The five-year survival was 57% in stage I, 21 -27% in stage I1 and IIIa, and 10% in stage IIIb. Of all resected patients, 4.2% died within two months after resection. In males, early postoperative mortality was predicted by preoperative bicycle ergometry. The prognosis in non-resected patients was poor, with only 2% surviving 5 years or longer. In conclusion, the results indicate that some progress has been made with regard to surgical management of lung cancer, but they also point to the fact that the vast majority of patients are not amenable to curative treatments, and that the overall survival in lung cancer has improved only marginally during the last decades.