- Email: [email protected]
Prognosis of lung cancer patients in Japan according to data from the Japanese Joint Committee of Lung Cancer Registry
respiratory investigation 52 (2014) 317–321
Contents lists available at ScienceDirect
Respiratory Investigation journal homepage: www.elsevier.com/locate/resinv
Review
Prognosis of lung cancer patients in Japan according to data from the Japanese Joint Committee of Lung Cancer Registry Noriyoshi Sawabata, MD, PhDa,b,n a
General Thoracic Surgery, Hoshigaoka Medical Center, Japan Community Health Care Organization, 4-8-1 Hoshigaoka, Hirakata City, Osaka 573-8511, Japan b Osaka University Graduate School of Medicine, 2-7 Yamadaoka, Suita City, Osaka 565-0871, Japan
art i cle i nfo
ab st rac t
Article history:
An organ-based lung cancer registry is currently maintained by the Japan Joint Committee
Received 6 April 2014
of Lung Cancer Registry; this registry contributes to the development of lung cancer
Received in revised form
treatments and provides TNM classification data. In Japan, the overall 5-year survival rate
25 April 2014
has improved over time to 52% in 2004; the corresponding rates for each pathologic stage
Accepted 30 April 2014
have also improved. Previously, separate registries were maintained for surgical and non-
Available online 17 June 2014
biased cases, whereas a prospective registry for non-surgical cases was added in 2012, and a follow-up examination of those data will be conducted in 2016. In addition, a registry of
Keywords:
surgical cases from 2010 will be constructed in 2016. The information provided by these
Lung cancer
registries should better reveal the status of lung cancer patients in Japan.
Registry
& 2014 The Japanese Respiratory Society. Published by Elsevier B.V. Open access under
Survival
CC BY-NC-ND license.
Japan
Contents 1. Introduction. . . . . . . . . 2. Materials and methods 3. Results . . . . . . . . . . . . . 4. Discussion . . . . . . . . . . 5. Conclusion . . . . . . . . . . Conflict of interest . . . . . . . References . . . . . . . . . . . . .
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. 318 . 319 . 320 . 321 . 321 . 321 . 321
Abbreviations: JJCLCR, Japan Joint Committee of Lung Cancer Registry; 5-YSR, 5-year survival rate n Correspondence address: General Thoracic Surgery, Hoshigaoka Medical Center, Japan Community Health Care Organization, 4-8-1 Hoshigaoka, Hirakata City, Osaka 573-8511, Japan. Tel.: þ81 72 840 2641, +81 6 6879 2595; fax: þ81 72 840 2266, +81 6 6879 2595. E-mail addresses: [email protected], [email protected] http://dx.doi.org/10.1016/j.resinv.2014.04.002 2212-5345/& 2014 The Japanese Respiratory Society. Published by Elsevier B.V. Open access under CC BY-NC-ND license.
318
1.
respiratory investigation 52 (2014) 317 –321
Introduction
Two types of Japanese cancer registries exist: a “populationbased” registry that depends on information provided by hospitals and an “organ-based” cancer registry that is maintained by academic organizations. The population-based
cancer registry produces domestic reports, including the numbers of patients, survival rates, and other information, that demonstrate the level of medical care provided in Japan. In contrast, the organ-based cancer registry deals with academic issues. Regarding lung cancer, the Japan Joint Committee of Lung Cancer Registry (JJCLCR) has established an organ-based
Table 1 – Findings from the registries of surgical cases. Year 1994
1999
n
(%)
2004
n
(%)
n
Total
7408
13344
11663
No. institute
303
386
253
(%)
Age (years) Mean
64.5
o50
615
(8.3)
65.8 877
(6.6)
66.7 596
(5.1)
50–60
1334
(18.0)
2312
(17.3)
2065
(17.7)
60–70
2984
(40.4)
4610
(34.5)
3712
(31.8)
70–80
2222
(30.1)
4823
(36.1)
4584
(39.3)
480
233
(3.1)
602
(4.5)
705
(6.0)
Missing
5
(0.1)
223
(1.6)
1
(0.0)
Male
5154
(69.7)
8878
(66.5)
7369
(63.2)
Female
2197
(29.7)
4344
(32.6)
4264
(36.8)
Missing
42
(0.6)
122
(0.9)
0
(0.0)
o1.0
249
(3.4)
746
(5.6)
1057
(9.1)
1.0–1.5
526
(7.1)
1227
(9.2)
1459
(12.5)
1.5–2.0
942
(12.7)
1972
(14.8)
1787
(15.3)
2.0–2.5
952
(12.9)
1824
(14.3)
1730
(14.8)
2.5–3.0
926
(12.5)
1527
(11.4)
1336
(11.5)
43.0
3745
(50.6)
5768
(43.5)
3294
(36.7)
Missing
53
(0.7)
240
(1.8)
0
(0.0)
Adenocarcinoma
4116
(55.7)
8239
(61.7)
7921
(67.9)
Squamous cell carcinoma
2441
(33.0)
3700
(27.7)
2600
(22.3)
Large cell carcinoma
266
(3.6)
474
(3.6)
387
(3.2)
Adeno-squamous cell carcinoma
185
(2.5)
204
(1.6)
225
(1.9)
Small cell carcinoma
248
(3.4)
390
(2.9)
243
(2.1)
Others
129
(0.8)
265
(1.9)
287
(2.5)
Missing
8
(0.1)
69
(0.5)
0
(0.0)
4354
(58.9)
9181
(68.8)
9083
(77.9)
3715
(30.3)
7810
(48.5)
7048
(56.5)
Gender
Tumor size (cm)
Tumor histology
c-Stage (Ver. 6) Ia, Ib p-Stage (Ver. 6) Ia, Ib
Table 2 – Perioperative complications and deaths among surgical cases. 1994 n Total Complications (Grade Z 3) Yes No Missing Deaths Operative ( r30 days) Hospital (430 days) Lung cancer Other cancer Other disease Unknown Missing
1999 (%)
7393
n
2004 (%)
13344
n
(%)
11663
1422 11913 9
(10.7) (89.3) (0.1)
523 11140 0
(4.5) (95.5) (0)
101 122 2635 124 461
(1.4) (1.7) (35.6) (1.7) (6.2)
123 146 3397 183 680
(0.9) (1.1) (25.4) (1.4) (5.1)
48 46 2459 215 570
(0.4) (0.4) (21.1) (1.8) (4.9)
272
(1.9)
148 21
(2.0) (0.3)
87 0
(0.7) (0.0)
319
respiratory investigation 52 (2014) 317 –321
Table 3 – Changes in surgical case survival rates. 1994
1999
2004
Ver. 6
Ver. 6
Ver. 6
n
(%)
7238
5-YSR (%)
n
52
13344
(%)
5-YSR (%)
n
62
11663
Ver. 7 (%)
5-YSR (%)
n
70
11663
(%)
5-YSR (%)
Total c-Stage IA IB IIA IIB IIIA IIIB IV Missing Total
70
2618 1646 169 793 1385 395 162 70 7168
30.2 23.0 2.4 11.1 19.3 5.5 2.3
72 50 48 40 35 28 20
5939 3242 226 1304 1723 567 211 132 13212
45.0 24.5 1.7 9.9 13.0 4.3 1.6
77 60 54 44 38 34 27
6295 2788 203 899 940 407 131 0 11663
54.0 23.9 1.7 7.7 8.1 3.5 1.1
82 63 55 49 43 42 29
6295 2339 819 648 1216 90 256 0 11663
54.0 20.1 7.0 5.6 10.4 0.1 2.2
82 66 55 46 43 40 31
p-Stage IA IB IIA IIB IIIA IIIB IV Missing Total
2142 1488 261 785 1337 759 275 191 7047
30.4 21.1 3.7 11.1 19.0 10.8 3.9
79 60 59 42 28 20 19
5007 2803 400 1388 1944 1179 397 226 13118
38.2 21.4 3.0 10.6 14.8 9.0 3.0
83 66 60 47 32 30 23
5611 2398 336 977 1354 799 188 0 11663
48.1 20.4 2.9 8.4 11.6 6.9 1.6
86 69 61 52 41 37 28
4978 2552 941 848 1804 106 434 0 11663
42.7 21.9 8.1 7.3 15.5 0.9 3.7
87 74 62 60 50 38 38
5-YSR, 5-year survival rate.
Table 4 – Prognostic analyses of non-biased and nonsurgical cases according to the histological type among patients treated in 2002. Non-small cell lung cancer Non-biased
Total c-Stage IA IB IIA IIB IIIA IIIB IV
Small cell lung cancer No surgery
Non-biased
No surgery
n
(%)
5-YSR (%)
n
(%)
5-YSR (%)
n
(%)
5-YSR (%)
n
(%)
5-YSR (%)
12,993
(100)
47
4452
(100)
5
1323
(100)
15
1088
(100)
5
4020 2113 184 860 1441 1714 2447
(31.0) (16.4) (1.4) (6.6) (11.1) (13.2) (18.5)
80 57 49 42 31 17 6
150 179 34 156 519 1270 2144
(3.5) (4.0) (0.8) (3.5) (11.7) (25.3) (48.1)
41 16 11 16 7 9 4
96 57 20 40 211 356 533
(7.3) (4.3) (1.5) (3.0) (16.7) (26.9) (40.3)
53 39 32 30 17 12 4
10 12 11 20 126 356 533
(0.9) (1.1) (1.0) (1.8) (11.5) (32.7) (49.0)
32 18 30 16 17 16 5
5-YSR, 5-year survival rate.
cancer registry in connection with 4 Japanese academic organizations: the Japan Lung Cancer Society, Japanese Association for Chest Surgery, Japanese Respiratory Society, and Japanese Society for Respiratory Endoscopy. This registry includes the characteristics of lung cancer patients nationwide and aims to contribute to treatment development and to offer data to support the TNM classification organized by the Union for International Cancer Control, American Joint Committee on Cancer, and International Association for the Study of Lung Cancer [1]. Of the 2 different types of Japanese lung cancer registries, the population-based registry depends on the conventional TNM classification system, whereas the
organ-based registry collects new information intended to validate the new TNM staging program. In this review, we analyzed the prognoses of lung cancer patients in Japan according to data from the JJCLCR.
2.
Materials and methods
Registries of surgical cases performed in 1994, 1999, and 2004 were added to the registry in 1999, 2004, and 2010, respectively, along with patient background information [2–4]. In addition, surgical and non-surgical (non-biased) cases treated
320
respiratory investigation 52 (2014) 317 –321
in 2002 were registered and analyzed in 2009 [5]. Using data from those registries, we assessed the trend of lung cancer patient prognoses in Japan.
3.
Results
The findings from the registries of surgical cases in 1994, 1999, and 2004 are summarized in Table 1. The mean patient age and the proportions of older patients, female patients, small-sized tumors, adenocarcinoma, and stage I tumors have increased over time. The perioperative complications and deaths are summarized in Table 2. The rates of perioperative and hospital deaths as well as the rates of complications have decreased over time. In 2004, the rate of grade Z 3
complications was 4.5%, whereas the rates of perioperative and hospital deaths were 4.5% and 0.4%, respectively. Changes in the survival rate are summarized in Table 3. The overall 5-year survival rate (5-YSR) improved over time and was 52% for surgical patients in 2004. In addition, the 5-YSR for each pathologic stage also improved over time. The survival curves of surgical patients at each pathological stage in 2004 are shown in Fig. 1a, whereas those of patients with small cell lung cancer are shown in Fig. 1b. The surgical and non-surgical (non-biased) cases treated in 2002 were registered and analyzed in 2009. The results of the prognostic analyses are summarized in Table 4, which shows that the overall 5-YSR for non-small cell lung cancer patients was 47% and that for small cell lung cancer patients
1 1 0.8 Actuarial survival
Actuarial survival
0.8
0.6
0.4
0.6
0.4
0.2
0.2
0
0 0
10
20
30
40
50
0
60
10
20
30
50
60
40
50
60
1
1
0.8
0.8
IA
Actuarial survival
Actuarial survival
40 Months
Months
IB
0.6
IIA
0.4
IIB B IIIA
0.2 0 10
20
30
40
0.4
0.2
0
IV 0
0.6
50
60
Months
Fig. 1 – Survival curves for surgical patients in 2004. (a) The survival rates according to pathological stage (Ver. 7) were 87% among stage IA patients (n ¼4978), 74% among stage IB patients (n¼ 2552), 62% among stage IIA patients (n ¼941), 60% among stage IIB patients (n ¼848), 50% among stage IIIA patients (n¼ 1804), 38% among stage IIIB patients (n¼ 106), and 38% among stage IV patients (n ¼ 434). (b) The survival rates of patients with small cell lung cancer according to the pathological stage (Ver. 7) were 72% among stage IA patients (n¼ 93), 61% among stage IB patients (n ¼51), 45% among stage IIA patients (n ¼ 27), 40% among stage IIB patients (n¼ 17), 23% among stage IIIA patients (n ¼45), and 9% among stage IV patients (n ¼ 9); all stage IIIB patients (n ¼ 1) were censored.
0
10
20
30 Months
Fig. 2 – Survival curves for non-surgical patients in 2002. (a) The survival rates for patients with non-small cell lung cancer according to clinical stage (Ver. 6) were 41% for stage IA (n ¼159), 16% for stage IB (n ¼179), 11% for stage IIA (n ¼ 34), 16% for stage IIB (n ¼156), 7% for stage IIIA (n¼ 519), 9% for stage IIIB (n ¼1270), and 4% for stage IV (n ¼ 2144). The survival rate for all non-small cell lung cancer patients was 5% (n ¼ 4452). (b) The survival rates for patients with small cell lung cancer according to clinical stage (Ver. 6) were 32% for stage IA (n ¼ 10), 18% for stage IB (n ¼12), 30% for stage IIA (n ¼ 11), 16% for stage IIB (n ¼20), 17% for stage IIIA (n¼ 126), 16% for stage IIIB (n ¼ 356), and 5% for stage IV (n ¼533). The survival rate for all small cell lung cancer patients was 5% (n ¼ 1088).
respiratory investigation 52 (2014) 317 –321
was 15%. Additionally, the extracted results with respect to the survival of non-surgical cases are shown in Fig. 2.
321
Conflict of interest The author has no conflicts of interest.
4.
Discussion r e f e r e nc e s
Previously, registries were constructed for surgical and nonbiased cases; however, a prospective registry for non-surgical cases was constructed with 410,000 registered cases in 2012, and a follow-up examination of those data is scheduled to be performed in 2016. In this registry, the status of epidermal growth factor receptor mutations and fluorodeoxyglucosepositron emission tomography examination findings will also be investigated. Additionally, a registry for surgical cases treated in 2010 will be constructed in 2016.
5.
Conclusion
Data from the JJCLCR revealed that the overall 5-YSR for surgical cases has improved over time to reach 52% in 2004. Additionally, in 2002, among non-biased patients, the overall 5-YSR for non-small cell lung cancer patients was 47% and that for small cell lung cancer patients was 15%. Future registries will continue to reveal the status of lung cancer patients in Japan.
[1] Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007;2:706–14. [2] Goya T, Asamura H, Yoshimura H, et al. Prognosis of 6644 resected non-small cell lung cancers in Japan: a Japanese lung cancer registry study. Lung Cancer 2005;50:227–34. [3] Asamura H, Goya T, Koshiishi Y, et al. A Japanese Lung Cancer Registry study: prognosis of 13,010 resected lung cancers. J Thorac Oncol 2008;3:46–52. [4] Sawabata N, Asamura H, Goya T, et al. Japanese Lung Cancer Registry Study: first prospective enrollment of a large number of surgical and nonsurgical cases in 2002. J Thorac Oncol 2010;5:1369–75. [5] Koike T, Yamato Y, Asamura H, et al. Improvements in surgical results for lung cancer from 1989 to 1999 in Japan. J Thorac Oncol 2009;4:1364–9.
Contents lists available at ScienceDirect
Respiratory Investigation journal homepage: www.elsevier.com/locate/resinv
Review
Prognosis of lung cancer patients in Japan according to data from the Japanese Joint Committee of Lung Cancer Registry Noriyoshi Sawabata, MD, PhDa,b,n a
General Thoracic Surgery, Hoshigaoka Medical Center, Japan Community Health Care Organization, 4-8-1 Hoshigaoka, Hirakata City, Osaka 573-8511, Japan b Osaka University Graduate School of Medicine, 2-7 Yamadaoka, Suita City, Osaka 565-0871, Japan
art i cle i nfo
ab st rac t
Article history:
An organ-based lung cancer registry is currently maintained by the Japan Joint Committee
Received 6 April 2014
of Lung Cancer Registry; this registry contributes to the development of lung cancer
Received in revised form
treatments and provides TNM classification data. In Japan, the overall 5-year survival rate
25 April 2014
has improved over time to 52% in 2004; the corresponding rates for each pathologic stage
Accepted 30 April 2014
have also improved. Previously, separate registries were maintained for surgical and non-
Available online 17 June 2014
biased cases, whereas a prospective registry for non-surgical cases was added in 2012, and a follow-up examination of those data will be conducted in 2016. In addition, a registry of
Keywords:
surgical cases from 2010 will be constructed in 2016. The information provided by these
Lung cancer
registries should better reveal the status of lung cancer patients in Japan.
Registry
& 2014 The Japanese Respiratory Society. Published by Elsevier B.V. Open access under
Survival
CC BY-NC-ND license.
Japan
Contents 1. Introduction. . . . . . . . . 2. Materials and methods 3. Results . . . . . . . . . . . . . 4. Discussion . . . . . . . . . . 5. Conclusion . . . . . . . . . . Conflict of interest . . . . . . . References . . . . . . . . . . . . .
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. 318 . 319 . 320 . 321 . 321 . 321 . 321
Abbreviations: JJCLCR, Japan Joint Committee of Lung Cancer Registry; 5-YSR, 5-year survival rate n Correspondence address: General Thoracic Surgery, Hoshigaoka Medical Center, Japan Community Health Care Organization, 4-8-1 Hoshigaoka, Hirakata City, Osaka 573-8511, Japan. Tel.: þ81 72 840 2641, +81 6 6879 2595; fax: þ81 72 840 2266, +81 6 6879 2595. E-mail addresses: [email protected], [email protected] http://dx.doi.org/10.1016/j.resinv.2014.04.002 2212-5345/& 2014 The Japanese Respiratory Society. Published by Elsevier B.V. Open access under CC BY-NC-ND license.
318
1.
respiratory investigation 52 (2014) 317 –321
Introduction
Two types of Japanese cancer registries exist: a “populationbased” registry that depends on information provided by hospitals and an “organ-based” cancer registry that is maintained by academic organizations. The population-based
cancer registry produces domestic reports, including the numbers of patients, survival rates, and other information, that demonstrate the level of medical care provided in Japan. In contrast, the organ-based cancer registry deals with academic issues. Regarding lung cancer, the Japan Joint Committee of Lung Cancer Registry (JJCLCR) has established an organ-based
Table 1 – Findings from the registries of surgical cases. Year 1994
1999
n
(%)
2004
n
(%)
n
Total
7408
13344
11663
No. institute
303
386
253
(%)
Age (years) Mean
64.5
o50
615
(8.3)
65.8 877
(6.6)
66.7 596
(5.1)
50–60
1334
(18.0)
2312
(17.3)
2065
(17.7)
60–70
2984
(40.4)
4610
(34.5)
3712
(31.8)
70–80
2222
(30.1)
4823
(36.1)
4584
(39.3)
480
233
(3.1)
602
(4.5)
705
(6.0)
Missing
5
(0.1)
223
(1.6)
1
(0.0)
Male
5154
(69.7)
8878
(66.5)
7369
(63.2)
Female
2197
(29.7)
4344
(32.6)
4264
(36.8)
Missing
42
(0.6)
122
(0.9)
0
(0.0)
o1.0
249
(3.4)
746
(5.6)
1057
(9.1)
1.0–1.5
526
(7.1)
1227
(9.2)
1459
(12.5)
1.5–2.0
942
(12.7)
1972
(14.8)
1787
(15.3)
2.0–2.5
952
(12.9)
1824
(14.3)
1730
(14.8)
2.5–3.0
926
(12.5)
1527
(11.4)
1336
(11.5)
43.0
3745
(50.6)
5768
(43.5)
3294
(36.7)
Missing
53
(0.7)
240
(1.8)
0
(0.0)
Adenocarcinoma
4116
(55.7)
8239
(61.7)
7921
(67.9)
Squamous cell carcinoma
2441
(33.0)
3700
(27.7)
2600
(22.3)
Large cell carcinoma
266
(3.6)
474
(3.6)
387
(3.2)
Adeno-squamous cell carcinoma
185
(2.5)
204
(1.6)
225
(1.9)
Small cell carcinoma
248
(3.4)
390
(2.9)
243
(2.1)
Others
129
(0.8)
265
(1.9)
287
(2.5)
Missing
8
(0.1)
69
(0.5)
0
(0.0)
4354
(58.9)
9181
(68.8)
9083
(77.9)
3715
(30.3)
7810
(48.5)
7048
(56.5)
Gender
Tumor size (cm)
Tumor histology
c-Stage (Ver. 6) Ia, Ib p-Stage (Ver. 6) Ia, Ib
Table 2 – Perioperative complications and deaths among surgical cases. 1994 n Total Complications (Grade Z 3) Yes No Missing Deaths Operative ( r30 days) Hospital (430 days) Lung cancer Other cancer Other disease Unknown Missing
1999 (%)
7393
n
2004 (%)
13344
n
(%)
11663
1422 11913 9
(10.7) (89.3) (0.1)
523 11140 0
(4.5) (95.5) (0)
101 122 2635 124 461
(1.4) (1.7) (35.6) (1.7) (6.2)
123 146 3397 183 680
(0.9) (1.1) (25.4) (1.4) (5.1)
48 46 2459 215 570
(0.4) (0.4) (21.1) (1.8) (4.9)
272
(1.9)
148 21
(2.0) (0.3)
87 0
(0.7) (0.0)
319
respiratory investigation 52 (2014) 317 –321
Table 3 – Changes in surgical case survival rates. 1994
1999
2004
Ver. 6
Ver. 6
Ver. 6
n
(%)
7238
5-YSR (%)
n
52
13344
(%)
5-YSR (%)
n
62
11663
Ver. 7 (%)
5-YSR (%)
n
70
11663
(%)
5-YSR (%)
Total c-Stage IA IB IIA IIB IIIA IIIB IV Missing Total
70
2618 1646 169 793 1385 395 162 70 7168
30.2 23.0 2.4 11.1 19.3 5.5 2.3
72 50 48 40 35 28 20
5939 3242 226 1304 1723 567 211 132 13212
45.0 24.5 1.7 9.9 13.0 4.3 1.6
77 60 54 44 38 34 27
6295 2788 203 899 940 407 131 0 11663
54.0 23.9 1.7 7.7 8.1 3.5 1.1
82 63 55 49 43 42 29
6295 2339 819 648 1216 90 256 0 11663
54.0 20.1 7.0 5.6 10.4 0.1 2.2
82 66 55 46 43 40 31
p-Stage IA IB IIA IIB IIIA IIIB IV Missing Total
2142 1488 261 785 1337 759 275 191 7047
30.4 21.1 3.7 11.1 19.0 10.8 3.9
79 60 59 42 28 20 19
5007 2803 400 1388 1944 1179 397 226 13118
38.2 21.4 3.0 10.6 14.8 9.0 3.0
83 66 60 47 32 30 23
5611 2398 336 977 1354 799 188 0 11663
48.1 20.4 2.9 8.4 11.6 6.9 1.6
86 69 61 52 41 37 28
4978 2552 941 848 1804 106 434 0 11663
42.7 21.9 8.1 7.3 15.5 0.9 3.7
87 74 62 60 50 38 38
5-YSR, 5-year survival rate.
Table 4 – Prognostic analyses of non-biased and nonsurgical cases according to the histological type among patients treated in 2002. Non-small cell lung cancer Non-biased
Total c-Stage IA IB IIA IIB IIIA IIIB IV
Small cell lung cancer No surgery
Non-biased
No surgery
n
(%)
5-YSR (%)
n
(%)
5-YSR (%)
n
(%)
5-YSR (%)
n
(%)
5-YSR (%)
12,993
(100)
47
4452
(100)
5
1323
(100)
15
1088
(100)
5
4020 2113 184 860 1441 1714 2447
(31.0) (16.4) (1.4) (6.6) (11.1) (13.2) (18.5)
80 57 49 42 31 17 6
150 179 34 156 519 1270 2144
(3.5) (4.0) (0.8) (3.5) (11.7) (25.3) (48.1)
41 16 11 16 7 9 4
96 57 20 40 211 356 533
(7.3) (4.3) (1.5) (3.0) (16.7) (26.9) (40.3)
53 39 32 30 17 12 4
10 12 11 20 126 356 533
(0.9) (1.1) (1.0) (1.8) (11.5) (32.7) (49.0)
32 18 30 16 17 16 5
5-YSR, 5-year survival rate.
cancer registry in connection with 4 Japanese academic organizations: the Japan Lung Cancer Society, Japanese Association for Chest Surgery, Japanese Respiratory Society, and Japanese Society for Respiratory Endoscopy. This registry includes the characteristics of lung cancer patients nationwide and aims to contribute to treatment development and to offer data to support the TNM classification organized by the Union for International Cancer Control, American Joint Committee on Cancer, and International Association for the Study of Lung Cancer [1]. Of the 2 different types of Japanese lung cancer registries, the population-based registry depends on the conventional TNM classification system, whereas the
organ-based registry collects new information intended to validate the new TNM staging program. In this review, we analyzed the prognoses of lung cancer patients in Japan according to data from the JJCLCR.
2.
Materials and methods
Registries of surgical cases performed in 1994, 1999, and 2004 were added to the registry in 1999, 2004, and 2010, respectively, along with patient background information [2–4]. In addition, surgical and non-surgical (non-biased) cases treated
320
respiratory investigation 52 (2014) 317 –321
in 2002 were registered and analyzed in 2009 [5]. Using data from those registries, we assessed the trend of lung cancer patient prognoses in Japan.
3.
Results
The findings from the registries of surgical cases in 1994, 1999, and 2004 are summarized in Table 1. The mean patient age and the proportions of older patients, female patients, small-sized tumors, adenocarcinoma, and stage I tumors have increased over time. The perioperative complications and deaths are summarized in Table 2. The rates of perioperative and hospital deaths as well as the rates of complications have decreased over time. In 2004, the rate of grade Z 3
complications was 4.5%, whereas the rates of perioperative and hospital deaths were 4.5% and 0.4%, respectively. Changes in the survival rate are summarized in Table 3. The overall 5-year survival rate (5-YSR) improved over time and was 52% for surgical patients in 2004. In addition, the 5-YSR for each pathologic stage also improved over time. The survival curves of surgical patients at each pathological stage in 2004 are shown in Fig. 1a, whereas those of patients with small cell lung cancer are shown in Fig. 1b. The surgical and non-surgical (non-biased) cases treated in 2002 were registered and analyzed in 2009. The results of the prognostic analyses are summarized in Table 4, which shows that the overall 5-YSR for non-small cell lung cancer patients was 47% and that for small cell lung cancer patients
1 1 0.8 Actuarial survival
Actuarial survival
0.8
0.6
0.4
0.6
0.4
0.2
0.2
0
0 0
10
20
30
40
50
0
60
10
20
30
50
60
40
50
60
1
1
0.8
0.8
IA
Actuarial survival
Actuarial survival
40 Months
Months
IB
0.6
IIA
0.4
IIB B IIIA
0.2 0 10
20
30
40
0.4
0.2
0
IV 0
0.6
50
60
Months
Fig. 1 – Survival curves for surgical patients in 2004. (a) The survival rates according to pathological stage (Ver. 7) were 87% among stage IA patients (n ¼4978), 74% among stage IB patients (n¼ 2552), 62% among stage IIA patients (n ¼941), 60% among stage IIB patients (n ¼848), 50% among stage IIIA patients (n¼ 1804), 38% among stage IIIB patients (n¼ 106), and 38% among stage IV patients (n ¼ 434). (b) The survival rates of patients with small cell lung cancer according to the pathological stage (Ver. 7) were 72% among stage IA patients (n¼ 93), 61% among stage IB patients (n ¼51), 45% among stage IIA patients (n ¼ 27), 40% among stage IIB patients (n¼ 17), 23% among stage IIIA patients (n ¼45), and 9% among stage IV patients (n ¼ 9); all stage IIIB patients (n ¼ 1) were censored.
0
10
20
30 Months
Fig. 2 – Survival curves for non-surgical patients in 2002. (a) The survival rates for patients with non-small cell lung cancer according to clinical stage (Ver. 6) were 41% for stage IA (n ¼159), 16% for stage IB (n ¼179), 11% for stage IIA (n ¼ 34), 16% for stage IIB (n ¼156), 7% for stage IIIA (n¼ 519), 9% for stage IIIB (n ¼1270), and 4% for stage IV (n ¼ 2144). The survival rate for all non-small cell lung cancer patients was 5% (n ¼ 4452). (b) The survival rates for patients with small cell lung cancer according to clinical stage (Ver. 6) were 32% for stage IA (n ¼ 10), 18% for stage IB (n ¼12), 30% for stage IIA (n ¼ 11), 16% for stage IIB (n ¼20), 17% for stage IIIA (n¼ 126), 16% for stage IIIB (n ¼ 356), and 5% for stage IV (n ¼533). The survival rate for all small cell lung cancer patients was 5% (n ¼ 1088).
respiratory investigation 52 (2014) 317 –321
was 15%. Additionally, the extracted results with respect to the survival of non-surgical cases are shown in Fig. 2.
321
Conflict of interest The author has no conflicts of interest.
4.
Discussion r e f e r e nc e s
Previously, registries were constructed for surgical and nonbiased cases; however, a prospective registry for non-surgical cases was constructed with 410,000 registered cases in 2012, and a follow-up examination of those data is scheduled to be performed in 2016. In this registry, the status of epidermal growth factor receptor mutations and fluorodeoxyglucosepositron emission tomography examination findings will also be investigated. Additionally, a registry for surgical cases treated in 2010 will be constructed in 2016.
5.
Conclusion
Data from the JJCLCR revealed that the overall 5-YSR for surgical cases has improved over time to reach 52% in 2004. Additionally, in 2002, among non-biased patients, the overall 5-YSR for non-small cell lung cancer patients was 47% and that for small cell lung cancer patients was 15%. Future registries will continue to reveal the status of lung cancer patients in Japan.
[1] Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007;2:706–14. [2] Goya T, Asamura H, Yoshimura H, et al. Prognosis of 6644 resected non-small cell lung cancers in Japan: a Japanese lung cancer registry study. Lung Cancer 2005;50:227–34. [3] Asamura H, Goya T, Koshiishi Y, et al. A Japanese Lung Cancer Registry study: prognosis of 13,010 resected lung cancers. J Thorac Oncol 2008;3:46–52. [4] Sawabata N, Asamura H, Goya T, et al. Japanese Lung Cancer Registry Study: first prospective enrollment of a large number of surgical and nonsurgical cases in 2002. J Thorac Oncol 2010;5:1369–75. [5] Koike T, Yamato Y, Asamura H, et al. Improvements in surgical results for lung cancer from 1989 to 1999 in Japan. J Thorac Oncol 2009;4:1364–9.