Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Characteristics and Prognostic Factors of Lung Cancer in Korea: A Pilot Study of Data from the Korean Nationwide Lung Cancer Registry

  • Kim, Ho Cheol (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Chi Young (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Cho, Deog Gon (Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jeon, Jae Hyun (Center for Lung Cancer, National Cancer Center) ;
  • Lee, Jeong Eun (Division of Pulmonology, Department of Internal Medicine, Chungnam National University) ;
  • Ahn, Jin Seok (Department of Medicine, Samsung Medical Center, Sungkyunkwan University) ;
  • Kim, Seung Joon (Division of Pulmonology, Department of Internal Medicine, The Cancer Research Institute, College of Medicine, The Catholic University of Korea) ;
  • Kim, Yeongdae (Department of Cardiothoracic Surgery, Pusan National University Hospital) ;
  • Kim, Young-Chul (Department of Pulmonary Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Kim, Jung-Eun (Cancer Registration and Statistics Branch, National Cancer Center) ;
  • Lee, Boram (Cancer Registration and Statistics Branch, National Cancer Center) ;
  • Won, Young-Joo (Cancer Registration and Statistics Branch, National Cancer Center) ;
  • Choi, Chang-Min (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2017.12.27
  • Accepted : 2018.04.12
  • Published : 2019.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Lung cancer is a leading cause of morbidity and mortality worldwide, and the incidence continues to rise. Although many prognostic factors have been identified, the clinical characteristics and outcomes in Korean lung cancer patients are not well defined. Methods: Of the 23,254 new lung cancer cases registered at the Korea Central Cancer Registry in 2013, total 489 patients from 19 hospitals were abstracted by the Korean Central Cancer Registry. The clinical data retrospectively analyzed, patients were followed up until December 2015. Results: The median age was 69 years (interquartile range, 60-74 years); 65.4% were male and 62.1% were ever-smokers. Cough was the most common initial symptom (33.5%); 13.1% of patients were asymptomatic. While squamous cell carcinoma was the most common subtype in male patients (37.2%), adenocarcinoma was the most frequent histological type in all patients (48.7%) and females (76.3%). The majority of patients received treatment (76.5%), which included surgery, radiation therapy, and chemotherapy. Older age (hazard ratio [HR], 1.037), lower body mass index (HR, 0.904), ever-smoker (HR, 2.003), small cell lung cancer (HR, 1.627), and distant metastasis (HR, 3.990) were independent predictors of mortality. Patients without symptoms (HR, 0.387) and without treatment (HR, 0.364) were associated with a favorable outcome in multivariate Cox analysis. Conclusion: Lung cancer in Korea occurs predominantly in elderly patients, with adenocarcinoma being the most frequent subtype. The prognosis was poorer in ever-smokers and older, malnourished, and untreated patients with advanced lung cancer.

Keywords

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin 2017;67:7-30. https://doi.org/10.3322/caac.21387
  2. Park EJ, Koh HK, Kwon JW, Suh MK, Kim H, Cho SI. Secular trends in adult male smoking from 1992 to 2006 in South Korea: age-specific changes with evolving tobacco-control policies. Public Health 2009;123:657-64. https://doi.org/10.1016/j.puhe.2009.09.007
  3. Park JY, Jang SH. Epidemiology of lung cancer in Korea: recent trends. Tuberc Respir Dis 2016;79:58-69. https://doi.org/10.4046/trd.2016.79.2.58
  4. Cho J, Choi SM, Lee J, Lee CH, Lee SM, Kim DW, et al. Proportion and clinical features of never-smokers with non-small cell lung cancer. Chin J Cancer 2017;36:20. https://doi.org/10.1186/s40880-017-0187-6
  5. Shin A, Oh CM, Kim BW, Woo H, Won YJ, Lee JS. Lung cancer epidemiology in Korea. Cancer Res Treat 2017;49:616-26. https://doi.org/10.4143/crt.2016.178
  6. Lee C, Kang KH, Koh Y, Chang J, Chung HS, Park SK, et al. Characteristics of lung cancer in Korea, 1997. Lung Cancer 2000;30:15-22. https://doi.org/10.1016/S0169-5002(00)00126-4
  7. In KH, Kwon YS, Oh IJ, Kim KS, Jung MH, Lee KH, et al. Lung cancer patients who are asymptomatic at diagnosis show favorable prognosis: a Korean Lung Cancer Registry Study. Lung Cancer 2009;64:232-7. https://doi.org/10.1016/j.lungcan.2008.08.005
  8. Oh CM, Won YJ, Jung KW, Kong HJ, Cho H, Lee JK, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2013. Cancer Res Treat 2016;48:436-50. https://doi.org/10.4143/crt.2016.089
  9. Lortet-Tieulent J, Soerjomataram I, Ferlay J, Rutherford M, Weiderpass E, Bray F. International trends in lung cancer incidence by histological subtype: adenocarcinoma stabilizing in men but still increasing in women. Lung Cancer 2014;84:13-22. https://doi.org/10.1016/j.lungcan.2014.01.009
  10. Janssen-Heijnen ML, Coebergh JW. The changing epidemiology of lung cancer in Europe. Lung Cancer 2003;41:245-58. https://doi.org/10.1016/S0169-5002(03)00230-7
  11. Gray N. The consequences of the unregulated cigarette. Tob Control 2006;15:405-8. https://doi.org/10.1136/tc.2006.017277
  12. Kenfield SA, Wei EK, Stampfer MJ, Rosner BA, Colditz GA. Comparison of aspects of smoking among the four histological types of lung cancer. Tob Control 2008;17:198-204. https://doi.org/10.1136/tc.2007.022582
  13. Hecht SS. Tobacco smoke carcinogens and lung cancer. J Natl Cancer Inst 1999;91:1194-210. https://doi.org/10.1093/jnci/91.14.1194
  14. Gallus S, Negri E, Boffetta P, McLaughlin JK, Bosetti C, La Vecchia C. European studies on long-term exposure to ambient particulate matter and lung cancer. Eur J Cancer Prev 2008;17:191-4. https://doi.org/10.1097/CEJ.0b013e3282f0bfe5
  15. Ahn YS, Kang SK. Asbestos-related occupational cancers compensated under the Industrial Accident Compensation Insurance in Korea. Ind Health 2009;47:113-22. https://doi.org/10.2486/indhealth.47.113
  16. Seow WJ, Matsuo K, Hsiung CA, Shiraishi K, Song M, Kim HN, et al. Association between GWAS-identified lung adenocarcinoma susceptibility loci and EGFR mutations in neversmoking Asian women, and comparison with findings from Western populations. Hum Mol Genet 2017;26:454-65. https://doi.org/10.1093/hmg/ddw414
  17. Kim HJ, Choi CM, Kim SG. The younger patients have more better prognosis in limited disease small cell lung cancer. Tuberc Respir Dis 2016;79:274-81. https://doi.org/10.4046/trd.2016.79.4.274
  18. Owonikoko TK, Ragin CC, Belani CP, Oton AB, Gooding WE, Taioli E, et al. Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database. J Clin Oncol 2007;25:5570-7. https://doi.org/10.1200/JCO.2007.12.5435
  19. Dawe DE, Ellis PM. The treatment of metastatic non-small cell lung cancer in the elderly: an evidence-based approach. Front Oncol 2014;4:178.
  20. Gandini S, Botteri E, Iodice S, Boniol M, Lowenfels AB, Maisonneuve P, et al. Tobacco smoking and cancer: a metaanalysis. Int J Cancer 2008;122:155-64. https://doi.org/10.1002/ijc.23033
  21. Choi S, Kim Y, Park S, Lee J, Oh K. Trends in cigarette smoking among adolescents and adults in South Korea. Epidemiol Health 2014;36:e2014023. https://doi.org/10.4178/epih/e2014023
  22. Lee SJ, Lee J, Park YS, Lee CH, Lee SM, Yim JJ, et al. Impact of smoking on mortality of patients with non-small cell lung cancer. Thorac Cancer 2014;5:43-9. https://doi.org/10.1111/1759-7714.12051
  23. Ferketich AK, Niland JC, Mamet R, Zornosa C, D'Amico TA, Ettinger DS, et al. Smoking status and survival in the national comprehensive cancer network non-small cell lung cancer cohort. Cancer 2013;119:847-53. https://doi.org/10.1002/cncr.27824
  24. Sardari Nia P, Weyler J, Colpaert C, Vermeulen P, Van Marck E, Van Schil P. Prognostic value of smoking status in operated non-small cell lung cancer. Lung Cancer 2005;47:351-9. https://doi.org/10.1016/j.lungcan.2004.08.011
  25. Taylor GM, Taylor AE, Thomas KH, Jones T, Martin RM, Munafo MR, et al. The effectiveness of varenicline versus nicotine replacement therapy on long-term smoking cessation in primary care: a prospective cohort study of electronic medical records. Int J Epidemiol 2017;46:1948-57. https://doi.org/10.1093/ije/dyx109
  26. Lim G, Park I, Park S, Song S, Kim H, Kim S. Effectiveness of smoking cessation using motivational interviewing in patients consulting a pulmonologist. Tuberc Respir Dis 2014;76:276-83. https://doi.org/10.4046/trd.2014.76.6.276
  27. Pauk N, Kubik A, Zatloukal P, Krepela E. Lung cancer in women. Lung Cancer 2005;48:1-9. https://doi.org/10.1016/j.lungcan.2004.10.009
  28. Shriver SP, Bourdeau HA, Gubish CT, Tirpak DL, Davis AL, Luketich JD, et al. Sex-specific expression of gastrin-releasing peptide receptor: relationship to smoking history and risk of lung cancer. J Natl Cancer Inst 2000;92:24-33. https://doi.org/10.1093/jnci/92.1.24
  29. Chakraborty S, Ganti AK, Marr A, Batra SK. Lung cancer in women: role of estrogens. Expert Rev Respir Med 2010;4:509-18. https://doi.org/10.1586/ers.10.50
  30. Gohagan J, Marcus P, Fagerstrom R, Pinsky P, Kramer B, Prorok P, et al. Baseline findings of a randomized feasibility trial of lung cancer screening with spiral CT scan vs chest radiograph: the Lung Screening Study of the National Cancer Institute. Chest 2004;126:114-21. https://doi.org/10.1378/chest.126.1.114
  31. Bar-Shalom R, Yefremov N, Guralnik L, Gaitini D, Frenkel A, Kuten A, et al. Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med 2003;44:1200-9.
  32. Postmus PE, Brambilla E, Chansky K, Crowley J, Goldstraw P, Patz EF Jr, et al. The IASLC Lung Cancer Staging Project: proposals for revision of the M descriptors in the forthcoming (seventh) edition of the TNM classification of lung cancer. J Thorac Oncol 2007;2:686-93. https://doi.org/10.1097/JTO.0b013e31811f4703
  33. Roh MS. Molecular pathology of lung cancer: current status and future directions. Tuberc Respir Dis 2014;77:49-54. https://doi.org/10.4046/trd.2014.77.2.49
  34. Yoon SH. Immunotherapy for non-small cell lung cancer. Tuberc Respir Dis 2014;77:111-5. https://doi.org/10.4046/trd.2014.77.3.111
  35. Kim SW, Kim MY, Lee YP, Ryu YJ, Lee SJ, Lee JH, et al. Clinical features and prognostic factors in elderly koreans with advanced non-small-cell lung cancer in a tertiary referral hospital. Tuberc Respir Dis 2013;75:52-8. https://doi.org/10.4046/trd.2013.75.2.52
  36. Matsunaga T, Suzuki K, Imashimizu K, Banno T, Takamochi K, Oh S. Body mass index as a prognostic factor in resected lung cancer: obesity or underweight, which is the risk factor? Thorac Cardiovasc Surg 2015;63:551-7. https://doi.org/10.1055/s-0035-1554964
  37. Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;160:1856-61. https://doi.org/10.1164/ajrccm.160.6.9902115
  38. Alakhras M, Decker PA, Nadrous HF, Collazo-Clavell M, Ryu JH. Body mass index and mortality in patients with idiopathic pulmonary fibrosis. Chest 2007;131:1448-53. https://doi.org/10.1378/chest.06-2784
  39. Tilg H, Moschen AR. Adipocytokines: mediators linking adipose tissue, inflammation and immunity. Nat Rev Immunol 2006;6:772-83. https://doi.org/10.1038/nri1937
  40. Savino W. The thymus gland is a target in malnutrition. Eur J Clin Nutr 2002;56 Suppl 3:S46-9. https://doi.org/10.1038/sj.ejcn.1601485

Cited by

  1. The Development of the Korean Lung Cancer Registry (KALC-R) vol.82, pp.2, 2019, https://doi.org/10.4046/trd.2018.0032
  2. Trends and Updated Statistics of Lung Cancer in Korea vol.82, pp.2, 2019, https://doi.org/10.4046/trd.2019.0015
  3. Epigenome-Wide Association Analysis of Differentially Methylated Signals in Blood Samples of Patients with Non-Small-Cell Lung Cancer vol.8, pp.9, 2019, https://doi.org/10.3390/jcm8091307
  4. Effect of medical thoracoscopy‐guided intrapleural docetaxel therapy to manage malignant pleural effusion in patients with non‐small cell lung cancer: A pilot study vol.10, pp.10, 2019, https://doi.org/10.1111/1759-7714.13158
  5. Report of the Korean Association of Lung Cancer Registry (KALC-R), 2014 vol.51, pp.4, 2019, https://doi.org/10.4143/crt.2018.704
  6. MicroRNA-374a Expression as a Prognostic Biomarker in Lung Adenocarcinoma vol.53, pp.6, 2019, https://doi.org/10.4132/jptm.2019.10.01
  7. miR-196b-5p Promotes Proliferation, Migration and Invasion of Lung Adenocarcinoma Cells via Targeting RSPO2 vol.12, 2019, https://doi.org/10.2147/cmar.s274171
  8. High PD-L1 Expression is Associated with Unfavorable Clinical Outcome in EGFR -Mutated Lung Adenocarcinomas Treated with Targeted Therapy vol.13, 2019, https://doi.org/10.2147/ott.s271011
  9. Profiles of Immune Infiltration and Prognostic Immunoscore in Lung Adenocarcinoma vol.2020, 2019, https://doi.org/10.1155/2020/5858092
  10. Current Status of Immunotherapy for Lung Cancer and Future Perspectives vol.83, pp.1, 2020, https://doi.org/10.4046/trd.2019.0039
  11. Air Pollution and Incidence of Lung Cancer by Histological Type in Korean Adults: A Korean National Health Insurance Service Health Examinee Cohort Study vol.17, pp.3, 2019, https://doi.org/10.3390/ijerph17030915
  12. Reactive oxygen species modulator 1 expression predicts lymph node metastasis and survival in early-stage non-small cell lung cancer vol.15, pp.12, 2019, https://doi.org/10.1371/journal.pone.0239670
  13. Serum Reactive Oxygen Species Modulator 1 as a Novel Predictive Biomarker for Resected Lung Adenocarcinoma: A Retrospective Pilot Study vol.14, 2021, https://doi.org/10.2147/ott.s336399
  14. Biomarkers and diagnostic tools for lung cancer vol.64, pp.1, 2019, https://doi.org/10.5124/jkma.2021.64.1.66
  15. Overexpression of Reactive Oxygen Species Modulator 1 Predicts Unfavorable Clinical Outcome in EGFR-Mutant Lung Adenocarcinomas Treated With Targeted Therapy vol.11, 2019, https://doi.org/10.3389/fonc.2021.770230
  16. Update on pharmacotherapy for smoking cessation vol.64, pp.3, 2019, https://doi.org/10.5124/jkma.2021.64.3.216
  17. 국가유공자 암환자의 생존율 vol.31, pp.1, 2019, https://doi.org/10.4332/kjhpa.2021.31.1.35
  18. Treatment outcomes and safety of afatinib in advanced squamous cell lung cancer progressed after platinum‐based doublet chemotherapy and immunotherapy ( SPACE study) vol.12, pp.8, 2019, https://doi.org/10.1111/1759-7714.13880
  19. Awareness and Use of Complementary and Alternative Medicine in Korean Lung Cancer Patients vol.84, pp.2, 2021, https://doi.org/10.4046/trd.2020.0098
  20. Recent Trends of Lung Cancer in Korea vol.84, pp.2, 2021, https://doi.org/10.4046/trd.2020.0134
  21. Current advances in the treatment of lung cancer with immune checkpoint inhibitors vol.64, pp.5, 2021, https://doi.org/10.5124/jkma.2021.64.5.333