Clinical profile of lung cancer in North India: A 10-year analysis of 1862 patients from a tertiary care center

Anant Mohan; Avneet Garg; Aditi Gupta; Satyaranjan Sahu; Chandrashekhar Choudhari; Vishal Vashistha; Ashraf Ansari; Rambha Pandey; Ashu Seith Bhalla; Karan Madan; Vijay Hadda; Hariharan Iyer; Deepali Jain; Rakesh Kumar; Saurabh Mittal; Pawan Tiwari; Ravindra M Pandey; Randeep Guleria

doi:10.4103/lungindia.lungindia_333_19

Clinical profile of lung cancer in North India: A 10-year analysis of 1862 patients from a tertiary care center

Lung India. 2020 May-Jun;37(3):190-197. doi: 10.4103/lungindia.lungindia_333_19.

Authors

Anant Mohan¹, Avneet Garg¹, Aditi Gupta¹, Satyaranjan Sahu¹, Chandrashekhar Choudhari¹, Vishal Vashistha², Ashraf Ansari¹, Rambha Pandey³, Ashu Seith Bhalla⁴, Karan Madan¹, Vijay Hadda¹, Hariharan Iyer¹, Deepali Jain⁵, Rakesh Kumar⁶, Saurabh Mittal¹, Pawan Tiwari¹, Ravindra M Pandey⁷, Randeep Guleria¹

Affiliations

¹ Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
² Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
³ Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India.
⁴ Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
⁵ Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
⁶ Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
⁷ Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Introduction: Over the past few years, the demographic profile of lung cancer has changed. However, most reports are limited by small numbers, short follow-up period, and show an inconsistent pattern. A comprehensive evaluation of changing trends over a long period has not been done.

Materials and methods: Consecutive lung cancer patients were studied over a 10-year period from January 2008 to March 2018 at the All India Institute of Medical Sciences, New Delhi, and relevant clinical information, and survival outcomes were analyzed.

Results: A total of 1862 patients were evaluated, with mean (SD) age of 59 (11.1) years, and comprising 82.9% males. Majority were smokers (76.2%) with median smoking index of 500 (interquartile range [IQR]: 300-800). Adenocarcinoma (ADC) was the most common type (34%), followed by squamous cell carcinoma (SCC - 28.6%) and small cell lung cancer (SCLC) (16.1%). Over the 10-year period, ADC increased from 9.5% to 35.9%, SCC from 25.4% to 30.6%, and non-small cell lung cancer -not otherwise specified (NSCLC-NOS) decreased from 49.2% to 21.4%. The proportion of females with lung cancer increased although smoking rates remained similar. Majority of NSCLC (95%) continued to be diagnosed at an advanced stage (3 or 4). Epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements were present in 25.3% and 11.5% ADC patients, respectively. The median overall survival was 8.8 months (IQR 3.7-19) for all patients and 12.57 (IQR 6.2-28.7) months among the 1013 patients who were initiated on specific treatment (chemotherapy, targeted therapy, radiotherapy, or surgery). Never-smokers were younger, more likely to be female and educated, had a higher prevalence of ADC and EGFR/ALK mutations, and had better survival.

Conclusion: Among this large cohort, our center seems to follow the global trend with increasing incidence of ADC. EGFR mutation positivity was similar to existing reports, while higher ALK positivity was detected. A characteristic phenotype of never-smokers with lung cancer was elucidated which demonstrated better survival.

Keywords: India; lung cancer; smoking; trends.