Longitudinal analysis of 2293 NSCLC patients: A comprehensive study from the TYROL registry

Highlights

• Cumulative analysis of a large NSCLC cohort.

• Detailed information on symptoms and comorbidities at diagnosis.

• Correlation of baseline characteristics and outcome.

• Step-by-step analysis of response and outcome in different therapeutic settings.

Abstract

Introduction

The aim of this study was to describe a large consecutive cohort of non-small cell lung cancer (NSCLC) patients treated in daily routine within the last 25 years. An extensive list of general baseline characteristics (comorbidities, laboratory values, symptoms, performance state), NSCLC related factors (stage, histology), treatment related parameters (approach, applied therapies) and outcome (PFS, RFS, OS, perspective of decades) were analyzed in detail.

Patients and methods

Medical files of 2293 consecutive NSCLC patients diagnosed between 1989 and 2009 at the Medical University of Innsbruck and affiliated hospitals were retrospectively analyzed. Patients were documented within our institution's comprehensive lung cancer project “Twenty-Year Retrospective of Lung Cancer (TYROL study)”.

Results

Mean age at diagnosis was 64.1 years and 1611 patients (70.3%) were male. Most patients were diagnosed in stage IV (37.9%). The most frequent comorbidities present at diagnosis were cardiovascular disease (62.1%) and COPD (62.0%). The most common symptoms at diagnosis were coughing (54.7%) and dyspnea (45.3%). Of all 2293 patients 1981 (86.4%) received adequate antineoplastic treatment. In total 874 patients were radically operated, 119 received radiotherapy/radio-chemotherapy and the majority of patients (n = 1278) were treated in palliative intent. A 2nd, 3rd, 4th and 5th-line palliative therapy was administered to 612, 278, 102, and 36 patients.

Median OS, RFS and PFS were 16.4 months, 86.4 months and 5.1 months, respectively. A multitude of factors was associated with all three outcome variables. Of note, outcome has improved stepwise in the recent decade based on increased response rates leading to prolonged OS.

Conclusion

This work incorporates most clinical aspects relevant in the treatment of NSCLC and beyond. Therefore, this comprehensive analysis provides a definite benchmark for prognostication and epidemiology of NSCLC in a Western European society.

Introduction

There are constantly updated guidelines providing evidence-based advices on treatment of NSCLC (non-small cell lung cancer) (e.g. the ESMO guidelines) [1]. However literature offering a global view on the disease is sparse since most studies only focus on distinct aspects of the disease like: presenting symptoms [2], comorbidities [3], laboratory features [4], [5], different treatment approaches [6] or temporal trends [7]. In contrast the TYROL (Twenty-Year Retrospective of Lung Cancer) registry was started more than a decade ago in order to get a comprehensive and unbiased view on lung cancer and its treatment in a representative Western society in daily routine. The aim was, first of all to provide a holistic view on the disease lung cancer and secondly, to gain new detailed insights into clinical presentation, pathologic features and innovations in therapies in the course of time. Using this sequential, methological approach our group recently presented a cumulative analysis on small cell lung cancer [8]. In the second step of our registry analysis the focus is set on a definite view on NSCLC. Therefore, we retrospectively analyzed 2293 patients diagnosed with NSCLC within the delineate region of Tyrol/Austria over 20 years. Having representative data on NSCLC available we investigated whether or not advances in treatment have led to improvement of prognosis.