Histology-related variation in the treatment and survival of patients with lung carcinoma in Canada.

Objectives: The aim of the study was to examine histologic differences in lung cancer treatment and survival, and to define recent survival trends in Ottawa, Canada.

Methods: From 1994 to 2000, 3,237 patients with invasive lung cancer were registered at the Ottawa Regional Cancer Centre (ORCC) and were followed up to 31 December 2001. Five-year relative survival rates (RSRs) and relative excess risks (RERs) of dying were calculated by stage and dominant initial treatment modalities for major cellular histologies using a relative survival model.

Results: The overall 5-year survival rate was 14%, and female patients had significantly better survival. Patients with stage I and II non-small cell lung cancer (NSCLC) who were treated by surgery alone were more likely to survive (5-year RSRs were 72 and 48%, respectively) than those who received other treatments. Patients with stage III NSCLC had a 5-year survival rate of 9% after chemotherapy plus radiotherapy, whereas stage IV patients who received only chemotherapy had better survival for up to 2 years than patients with other treatments. In cases of limited-stage small cell lung cancer (SCLC), survival was better for patients who received chemotherapy plus radiotherapy than for those who received only chemotherapy.

Conclusions: The relatively superior survival of surgical patients with stage I NSCLC implies that a considerable number of patients have the potential to be treated successfully. The overall poor survival of lung cancer patients suggests a need for more national public health emphasis on lung cancer prevention, improved screening and early diagnosis, and better treatment.