Prognosis

Lung cancer survival rates are a measure of the proportion of people who remain alive with lung cancer after a certain amount of time. Survival rates for lung cancer vary depending on the subtype of cancer and at what stage the illness is diagnosed. The 1-year relative survival for lung cancer in the USA increased from 35% in 1975–1979 to 43% in 2003–2006, largely due to advances in surgical techniques and chemoradiotherapy. However, the prognosis also depends upon the histological type: for example, small cell lung cancer usually has a worse prognosis than nonsmall cell lung cancer.

The TNM (Tumour, Nodes, Metastases) system, which was updated for nonsmall cell lung cancer in 2010, is used by health professionals as a common way of staging cancer. In individual patients, the TNM system is used in decisions about treatment and prognosis. It is also used on a population basis to inform and assess treatment guidelines, cancer research and planning. The individual T, N and M scores are based, respectively, on the size and situation of the primary tumour (T1–T4), the extent of lymph node involvement (N0–N4), and recognition of the presence of metastases (M0 or M1). These scores are combined to give a stage (I–IV) for the cancer, with higher stages associated with shorter survival (table 2).

Treatment of lung cancer: current needs

  • Lung cancer patients should be investigated and treated as outpatients whenever possible. This should reduce the financial burden of the disease and decrease the psychological impact of the disease on patients and families.

  • Staging of lung cancer is critical to determine the prognosis and treatment options. Novel staging techniques (positron emission tomography (PET) scans, endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS)) should increasingly be made available in cancer centres as they will offer quick and accurate outpatient diagnosis and staging of the disease. Hospital admissions will be reduced and shorter time intervals from presentation until treatment decision will be achieved.

  • Targeted therapy: advances in tailoring chemotherapy to the type of lung cancer must be matched by the availability of diagnostic services for lung cancer phenotyping and genotyping.

  • The availability of lung-sparing radiotherapy techniques should increase in treatment centres throughout Europe. Intensity modulation radiation therapy (IMRT), gamma knife and image-guided radiation therapy are all high-precision modalities that allow tracking of respiratory movement during treatment, sparing of healthy lung tissue and reduced risk of radiation-induced lung toxicity.

Stage T N M 5-year survival %
Ia T1a N0 M0 50
  T1b N0 M0  
Ib T2a N0 M0 43
IIa T1a N1 M0 36
  T1b N1 M0  
  T2a N1 M0  
  T2b N0 M0  
IIb T2b N1 M0 25
  T3 N0 M0  
IIIa T1 N2 M0 19
  T2 N2 M0  
  T3 N2 M0  
  T3 N1 M0  
  T4 N0 M0  
  T4 N1 M0  
IIIb T4 N2 M0 7
  T1 N3 M0  
  T2 N3 M0  
  T3 N3 M0  
  T4 N3 M0  
IV T Any N Any M1a or 1b 2
Table 2 – The new TNM (Tumour, Node, Metastases) classification in nonsmall cell lung cancer with corresponding 5-year survival rates per stage. Ta and Tb refer respectively to larger and smaller primary tumours and M1a and M1b respectively to intrathoracic and distant metastases. Modified from International Union against Cancer, 2010 and see also details in Detterbeck et al., 2009.

The 5-year survival rate for patients with lung cancer of all stages combined remains poor, at only 12.6%. Figure 4 shows the age-adjusted 5-year relative survival, reported in 2008, of patients diagnosed in 2000–2002 in various European countries. Detailed comparisons between countries suggest that some differences (for example, the low survival rate in the UK) may be explained in part by presentation with more advanced disease due to poor population awareness and consequent late access to healthcare, but an effect of differences in diagnostic and therapeutic activity cannot be excluded.

See the entire Lung Cancer Chapter