title: [Evolution of species: Lung cancer evolution over one third of a century].
abstract: BACKGROUND
  Management of non-small cell lung cancer (NSCLC) is getting better and results on long-term survival have improved. We reviewed the modifications observed in surgery over a 32-year time period.
  
  
  METHODS
  Data of 6105 patients who underwent surgery from 1979 to 2010 were analyzed over three equal time-periods: gender, age, type of surgery, histology, pTNM, tobacco addiction, comorbidity and time periods.
  
  
  RESULTS
  Age, number of females and high-risk patients with comorbidity (including the history of a previous cancer) increased with time periods. Number of exploratory thoracotomy (7.7 % to 1.6 %) and pneumonectomy (48 % to 18 %) decreased. Number of wedge resection (0.5 % to 6 %) and lobectomy (42 % to 64 %) increased. Rates of the other types of resection were unchanged. Neoadjuvant treatments accounted for more than 20 % of patients in the last time period. Postoperative mortality (4 %) did not vary but non-lethal complication rates increased (16.9 % to 27.7 %). Global 5-year survival rates dramatically increased with time going from 37.4 % to 49.8 % (P<10(-6)). Survival improvement was observed in the different components of the pTNM and whatever the type of treatment. However, survival was affected by increasing age and multiplication of comorbidities but without impairing the general better outcome trend.
  
  
  CONCLUSIONS
  NSCLC itself, its diagnostic and therapeutic management, and patient's characteristics evolved with time. Survival improved in most studied prognosis factors. Time period factor was of paramount importance and might be included in research dealing with NSCLC.
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France. Electronic address: marc.riquet@egp.aphp.fr.
authors.forename: M
authors.initials: M
authors.lastname: Riquet
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Legras
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Pricopi
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Badia
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Arame
authors.affiliation: Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France.
authors.forename: A
authors.initials: A
authors.lastname: Dujon
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Foucault
authors.affiliation: Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Le Pimpec Barthes
authors.affiliation: Service d'oncologie médicale, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75015 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Fabre
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008175:Lung Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Cancer du poumon non à petites cellules; Chirurgie; Non-small cell lung cancer; Prognosis; Pronostic; Périodes de temps; Surgery; Time periods