Real-world data on severe lung cancer: a multicenter retrospective study

Fei Wang; Xiaohong Xie; Liqiang Wang; Haiyi Deng; Qian Wang; Min Qi; Min Guo; Juan Chen; Maolin Zhou; Ni Sun; Ru Li; Yilin Yang; Zuer He; Xinqing Lin; Ming Liu; Di Wu; Gengyun Sun; Chengzhi Zhou

doi:10.21037/tlcr-23-4

Real-world data on severe lung cancer: a multicenter retrospective study

Transl Lung Cancer Res. 2023 Mar 31;12(3):460-470. doi: 10.21037/tlcr-23-4. Epub 2023 Mar 27.

Authors

Fei Wang^#^{1

2}, Xiaohong Xie^#¹, Liqiang Wang^#^{1

3}, Haiyi Deng¹, Qian Wang², Min Qi², Min Guo⁴, Juan Chen⁴, Maolin Zhou¹, Ni Sun¹, Ru Li^{1

5}, Yilin Yang¹, Zuer He⁶, Xinqing Lin¹, Ming Liu¹, Di Wu⁴, Gengyun Sun², Chengzhi Zhou¹

Affiliations

¹ Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
² Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
³ College of Life Science, Henan University, Kaifeng, China.
⁴ Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital, Shenzhen, China.
⁵ School of Clinical Medicine, Henan University, Kaifeng, China.
⁶ Department of Clinical Medicine, Nan Shan School of Guangzhou Medical University, Guangzhou, China.

^# Contributed equally.

Abstract

Background: Severe lung cancer is a novel concept that describes a patient with poor performance status (PS; 2-4) but with a high probability of receiving survival benefit and improvement in the PS score. However, there is currently no relevant research or real-world data on those with severe lung cancer, such as incidence, cause, clinical features, and risk factors.

Methods: The data from patients with advanced lung cancer attending multiple centers from January 1, 2022, to June 30, 2022, were collected for a cross-sectional study. In addition, data from fatal cases from January 1, 2019, to June 30, 2022, were retrospectively collected as another cohort. And we developed a questionnaire to assess clinicians' mastery of severe lung cancer.

Results: Three participating institutes enrolled the data set of 1,725 patients, and the dataset of 269 fatal cases were included in another cohort; the incidence of severe lung cancer was 13.10% and 37.55%, respectively. Severe lung cancer patients were mainly stage IV elderly male patients without gene mutation and a history of resection. And the proportion of smoking and comorbidities in severe lung cancer patients is more than in non-severe lung cancer patients (50.4% vs. 40.8%, P=0.006; 46.9% vs. 36.4%, P=0.002). Treatment-related adverse events (AEs) (46.0%) accounted for the largest proportion of the primary causes of severe lung cancer in the cross-sectional study, while cancer-related symptoms (54.5%) accounted for the largest proportion of the primary causes of sever lung cancer in the 101 fatal cases. For the fatal cases, the overall survival of severe lung cancer patients caused by cancer-related symptoms was longer than that caused by treatment-related AEs (8 vs. 3 months; P=0.019). A total of 616 clinicians completed the questionnaire; 90.26% of clinicians agreed with the concept of severe lung cancer.

Conclusions: The incidence of severe lung cancer cannot be ignored based on real-world data. Treatment-related AEs are gradually account for more of the causes of severe lung cancer, surpassing cancer-related symptoms and comorbidities. Furthermore, the prognosis of patients with advanced lung cancer who develop severe lung cancer due to treatment-related AEs is worse than cancer-related symptoms.

Keywords: Severe lung cancer; cross-sectional study; prognosis; questionnaire; real-world data.