Lung cancer survival in England: trends in non-small-cell lung cancer survival over the duration of the National Lung Cancer Audit.
BACKGROUND
In comparison with other European and North American countries, England has poor survival figures for lung cancer. Our aim was to evaluate the changes in survival since the introduction of the National Lung Cancer Audit (NLCA).


METHODS
We used data from the NLCA to identify people with non-small-cell lung cancer (NSCLC) and stratified people according to their performance status (PS) and clinical stage. Using Cox regression, we calculated hazard ratios (HRs) for death according to the year of diagnosis from 2004/2005 to 2010; adjusted for patient features including age, sex and co-morbidity. We also assessed whether any changes in survival were explained by the changes in surgical resection rates or histological subtype.


RESULTS
In this cohort of 120,745 patients, the overall median survival did not change; but there was a 1% annual improvement in survival over the study period (adjusted HR 0.99, 95% confidence interval (CI) 0.98-0.99). Survival improvement was only seen in patients with good PS and early stage (adjusted HR 0.97, 95% CI 0.95-0.99) and this was partly accounted for by changes in resection rates.


CONCLUSIONS
Survival has only improved for a limited group of people with NSCLC and increasing surgical resection rates appeared to explain some of this improvement.
Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK.
A
A
Khakwani
A L
AL
Rich
H A
HA
Powell
L J
LJ
Tata
R A
RA
Stanley
D R
DR
Baldwin
J P
JP
Duffy
R B
RB
Hubbard
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D013510:Pulmonary Surgical Procedures / Q000706:statistics & numerical data; D012044:Regression Analysis; D015996:Survival Rate