Pneumology - Original Articles Open access

Survival among patients with lung cancer managed at a tertiary care center in North India

Authors

Published
26 July 2024
Section
Pneumology - Original Articles
DOI
10.4081/monaldi.2024.3045

Abstract

Though there has been advancement in the management of lung cancer, it is not well utilized due to its limited availability and high cost. This is a prospective observational study done at a tertiary care center from January 2014 to December 2022, involving patients with primary lung cancer. After tumor-node-metastasis staging and molecular testing, the patients received chemotherapy, radiotherapy, surgery, targeted therapy, and immunotherapy in various combinations as per the prevailing National Comprehensive Cancer Network Guidelines. A total of 92 patients were enrolled in the study, with a mean age of 58.94±10.33; 72 (78.26%) were males. 69 (75%) patients were either current or former smokers. 78 (84.78%) patients had an Eastern Cooperative Oncology Group (ECOG) score of 0-2, while the remaining had an ECOG of 3-4. 80 (86.95%) patients had non-small cell lung cancer (NSCLC) [44 (47.83%) adenocarcinoma, 25 (27.17%) squamous cell carcinoma, and 11 (11.95%) NSCLC: not otherwise specified], while 12 (13.04%) patients had small cell lung cancer. One (1.08%) patient each presented in stage I and stage II, 31 (33.69%) patients presented in stage III, and 59 (64.13%) patients presented in stage IV. 44 patients with adenocarcinoma were subjected to mutational analysis, and an epidermal growth factor receptor mutation was found in 13 (29.5%) patients. None of the patients had an ALK mutation, ROS-1 rearrangement, or BRAF mutation. PD-L1 expression was evaluated in 9 patients with NSCLC, and it was found in 6 (66.66%) patients. The overall mean survival was 12.7 months. The mean survival for patients with stages I, II, III, and IV was 70, 96, 8.1, and 12.7 months, respectively. Survival in stage IV was better than in stage III, as the eligible patients received targeted therapy and immunotherapy. Targeted therapy and immunotherapy have improved survival. Molecular analysis should be done whenever indicated, and eligible patients must be administered targeted therapy and immunotherapy.

Keywords

Ethics Approval

This research was approved by the institutional ethics committee (ESI-PGIMSR IEC/2021008).

References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424. DOI: https://doi.org/10.3322/caac.21492
  2. Deshpand R, Chandra M, Rauthan A. Evolving trends in lung cancer: epidemiology, diagnosis, and management. Indian J Cancer 2022;59:S90-105. DOI: https://doi.org/10.4103/ijc.IJC_52_21
  3. Singh N, Agrawal S, Jiwnani S, et al. Lung cancer in India. J Thorac Oncol 2021;16:1250-66. DOI: https://doi.org/10.1016/j.jtho.2021.02.004
  4. Groome PA, Bolejack V, Crowley JJ, et al. The IASLC lung cancer staging project: validation of the proposals for revision of the t, n, and m descriptors and consequent stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol 2007;2:694‑705. DOI: https://doi.org/10.1097/JTO.0b013e31812d05d5
  5. Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 2016;11:39‑51.
  6. Chevallier M, Borgeaud M, Addeo A, Friedlaender A. Oncogenic driver mutations in non-small cell lung cancer: past, present and future. World J Clin Oncol 2021;12:217-37. DOI: https://doi.org/10.5306/wjco.v12.i4.217
  7. Prasad R, James P, Kesarwani V, et al. Clinicopathological study of bronchogenic carcinoma. Respirology 2004;9:557‑60. DOI: https://doi.org/10.1111/j.1440-1843.2004.00600.x
  8. Dey A, Biswas D, Saha SK, et al. Comparison study of clinicoradiological profile of primary lung cancer cases: an eastern India experience. Indian J Cancer 2012;49:89‑95. DOI: https://doi.org/10.4103/0019-509X.98930
  9. Mandal SK, Singh TT, Sharma TD, Amrithalingam V. Clinico‑pathology of lung cancer in a regional cancer center in Northeastern India. Asian Pac J Cancer Prev 2013;14:7277‑81. DOI: https://doi.org/10.7314/APJCP.2013.14.12.7277
  10. Kaur H, Sehgal IS, Bal A, et al. Evolving epidemiology of lung cancer in India: reducing non‑small cell lung cancer‑not otherwise specified and quantifying tobacco smoke exposure are the key. Indian J Cancer 2017;54:285‑90. DOI: https://doi.org/10.4103/ijc.IJC_597_16
  11. Gadgeel SM, Ramalingam S, Cummings G, et al. Lung cancer in patients 50 years of age: The experience of an academic multidisciplinary program. Chest 1999;115:1232‑6. DOI: https://doi.org/10.1378/chest.115.5.1232
  12. Fu JB, Kau TY, Severson RK, Kalemkerian GP. Lung cancer in women: analysis of the national surveillance, epidemiology, and end results database. Chest 2005;127:768‑77. DOI: https://doi.org/10.1378/chest.127.3.768
  13. Stewart SL, Cardinez CJ, Richardson LC, et al. Surveillance for cancers associated with tobacco use - United States, 1999‑2004. MMWR Surveill Summ 2008;57:1‑33.
  14. Khan NA, Afroz F, Lone MMet al. Profile of lung cancer in Kashmir, India: a five‑year study. Indian J Chest Dis Allied Sci 2006;48:187‑90.
  15. Noronha V, Dikshit R, Raut N, et al. Epidemiology of lung cancer in India: focus on the differences between non‑smokers and smokers: a single‑centre experience. Indian J Cancer 2012;49:74‑81. DOI: https://doi.org/10.4103/0019-509X.98925
  16. Sharma PK, Bansal R. Profile of lung cancer in predominantly Bidi smoking rural population of northern Himachal Pradesh. Indian J Chest Dis Allied Sci 2013;55:75‑8. DOI: https://doi.org/10.5005/ijcdas-55-2-75
  17. Baburao A, Narayanswamy H. Clinico‑pathological profile and haematological abnormalities associated with lung cancer in Bangalore, India. Asian Pac J Cancer Prev 2015;16:8235‑8. DOI: https://doi.org/10.7314/APJCP.2015.16.18.8235
  18. Perng DW, Perng RP, Kuo BI, Chiang SC. The variation of cell type distribution in lung cancer: A study of 10,910 cases at a medical center in Taiwan between 1970 and 1993. Jpn J Clin Oncol 1996;26:229‑33. DOI: https://doi.org/10.1093/oxfordjournals.jjco.a023219
  19. Minami H, Yoshimura M, Miyamoto Y, et al. Lung cancer in women: sex‑associated differences in survival of patients undergoing resection for lung cancer. Chest 2000;118:1603‑9. DOI: https://doi.org/10.1378/chest.118.6.1603
  20. Radzikowska E, Głaz P, Roszkowski K. Lung cancer in women: age, smoking, histology, performance status, stage, initial treatment and survival. Population‑based study of 20 561 cases. Ann Oncol 2002;13:1087‑93. DOI: https://doi.org/10.1093/annonc/mdf187
  21. Gupta RC, Purohit SD, Sharma MP, Bhardwaj S. Primary bronchogenic carcinoma: Clinical profile of 279 cases from mid‑west Rajasthan. Indian J Chest Dis Allied Sci 1998;40:109‑16.
  22. Rawat J, Sindhwani G, Gaur D, et al. Clinico‑pathological profile of lung cancer in Uttarakhand. Lung India 2009;26:74‑6. DOI: https://doi.org/10.4103/0970-2113.53229
  23. Mohan A, Garg A, Gupta A, et al. Clinical profile of lung cancer in North India: a 10-year analysis of 1862 patients from a tertiary care center. Lung India 2020;37:190-7. DOI: https://doi.org/10.4103/lungindia.lungindia_333_19
  24. Wakelee HA, Dahlberg SE, Brahmer JR, et al. Differential effect of age on survival in advanced NSCLC in women versus men: analysis of recent Eastern Cooperative Oncology Group (ECOG) studies, with and without bevacizumab. Lung Cancer 2012;76:410‑5. DOI: https://doi.org/10.1016/j.lungcan.2011.12.006
  25. Schaafsma J, Osoba D. The Karnofsky performance status scale re‑examined: a cross‑validation with the EORTC‑C30. Qual Life Res 1994;3:413‑24. DOI: https://doi.org/10.1007/BF00435393
  26. Prasad R, Verma SK, Sanjay. Comparison between young and old patients with bronchogenic carcinoma. J Cancer Res Ther 2009;5:31‑5. DOI: https://doi.org/10.4103/0973-1482.44296
  27. Nations JA, Brown DW, Shao S, et al. Comparative trends in the distribution of lung cancer stage at diagnosis in the department of defense cancer registry and the surveillance, epidemiology, and end results data, 1989–2012. Mil Med 2020;185:e2044-8. DOI: https://doi.org/10.1093/milmed/usaa218
  28. Morgensztern D, Ng SH, Gao F, Govindan R. Trends in stage distribution for patients with nonsmall cell lung cancer: a national cancer database survey. J Thorac Oncol 2010;5:29-33. DOI: https://doi.org/10.1097/JTO.0b013e3181c5920c
  29. Fukuoka M, Wu YL, Thongprasert S, et al. Biomarker analyses and final overall survival results from a phase III, randomized, open‑label, first‑line study of gefitinib versus carboplatin/paclitaxel in clinically selected patients with advanced non‑small‑cell lung cancer in Asia (IPASS). J Clin Oncol 2011;29:2866‑74. DOI: https://doi.org/10.1200/JCO.2010.33.4235
  30. Sequist LV, Yang JC, Yamamoto N, et al. Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol 2013;31:3327‑34. DOI: https://doi.org/10.1200/JCO.2012.44.2806
  31. Shi Y, Au JS, Thongprasert S, et al. A prospective, molecular epidemiology study of EGFR mutations in Asian patients with advanced non‑small‑cell lung cancer of adenocarcinoma histology (PIONEER). J Thorac Oncol 2014;9:154‑62. DOI: https://doi.org/10.1097/JTO.0000000000000033
  32. Noronha V, Prabhash K, Thavamani A, et al. EGFR mutations in Indian lung cancer patients: Clinical correlation and outcome to EGFR targeted therapy. PLoS One 2013;8:e61561. DOI: https://doi.org/10.1371/journal.pone.0061561
  33. Doval DC, Azam S, Batra U, et al. Epidermal growth factor receptor mutation in lung adenocarcinoma in India: a single center study. J Carcinog 2013;12:12. DOI: https://doi.org/10.4103/1477-3163.114970
  34. Kota R, Gundeti S, Gullipalli M, et al. Prevalence and outcome of epidermal growth factor receptor mutations in non‑squamous non‑small cell lung cancer patients. Lung India 2015;32:561‑5. DOI: https://doi.org/10.4103/0970-2113.168099
  35. Veldore VH, Rao RM, Kakara S, et al. Epidermal growth factor receptor mutation in non‑small‑cell lung carcinomas: a retrospective analysis of 1036 lung cancer specimens from a network of tertiary cancer care centers in India. Indian J Cancer 2013;50:87‑93. DOI: https://doi.org/10.4103/0019-509X.117013
  36. Pikor LA, Ramnarine VR, Lam S, Lam WL. Genetic alterations defining NSCLC subtypes and their therapeutic implications. Lung Cancer 2013;82:179‑89. DOI: https://doi.org/10.1016/j.lungcan.2013.07.025
  37. Malik PS, Sharma MC, Mohanti BK, et al. Clinico‑pathological profile of lung cancer at AIIMS: a changing paradigm in India. Asian Pac J Cancer Prev 2013;14:489‑94. DOI: https://doi.org/10.7314/APJCP.2013.14.1.489
  38. Murali AN, Radhakrishnan V, Ganesan TS, et al. Outcomes in lung cancer: 9‑year experience from a tertiary cancer center in India. J Glob Oncol 2017;3:459‑68. DOI: https://doi.org/10.1200/JGO.2016.006676
  39. Rajappa S, Gundeti S, Talluri MR, Digumarti R. Chemotherapy for advanced lung cancer: a 5‑year experience. Indian J Cancer 2008;45:20‑6. DOI: https://doi.org/10.4103/0019-509X.40642
  40. Garg A, Iyer H, Jindal V, et al. Prognostic factors for treatment response and survival outcomes after first-line management of Stage 4 non-small cell lung cancer: a real-world Indian perspective. Lung India 2022;39:102-9. DOI: https://doi.org/10.4103/lungindia.lungindia_408_21

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.

PlumX Metrics

License

Copyright (c) 2024 The Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.