Stage Shift Tied to Decreased Population Mortality in NSCLC

A stage shift from later- to earlier-stage disease during the last decade was associated with improved survival among patients with non-small cell lung cancer, according to a study published online Dec. 17 in JAMA Network Open.

Raja Flores, M.D., from the Mount Sinai Health System in New York City, and colleagues used data from the Surveillance, Epidemiology, and End Results registries to identify 312,382 non-small cell lung cancer patients from 2006 to 2016. The association between stage shift and population mortality was assessed.

The researchers observed a significant association between year of diagnosis and clinical stage, with stage I/II diagnosis increasing from 26.5 to 31.2 percent (average annual percent change [AAPC], 1.5; 95 percent confidence interval [CI], 0.5 to 2.5) and stage III/IV diagnosis decreasing significantly from 70.8 to 66.1 percent (AAPC, −0.6; 95 percent CI, −1.0 to −0.2). There was a significant association between year of diagnosis and tumor histology. During the study period, there was a significant increase in adenocarcinomas (42.9 to 59.0 percent; AAPC, 3.4; 95 percent CI, 2.9 to 3.9). Median survival for stage I/II was 57 months, seven months for stage III/IV, and 10 months for those with a missing stage. When compared with patients with a known stage, those without stage information had significantly worse survival than those with stage I/II and survival ranging between those with stage III and IV.

“These findings suggest that studies investigating the effect of treatment on lung cancer must take into account stage shift and the confounding association with survival and mortality outcome,” the authors write.

One author disclosed serving as a commissioner on the Medicare Payment Advisory Commission outside the submitted work.

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