Mortality Predictors of Small-cell and Non-Small Cell Lung Cancer among Saudi Patients Open Access

Alghamdi, Hatim Issa (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/2v23vv19m?locale=en
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Abstract

Abstract

Background

Lung cancer ranks as the top cancer worldwide in terms of incidence and constitutes a major health problem. About 90% of lung cancer cases are diagnosed at advance stage where treatment is not available. Despite evidence that lung cancer screening improves survival, guidelines for lung cancer screening are still a subject for debate. In Saudi Arabia, only 14% of lung cancers are diagnosed at early stage and research on survival and its predictors is lacking. This study was conducted to assess predictors of lung cancer mortality according to the two major cancer types, small-cell lung cancers (SCLCs) and non-small cell lung cancers (NSCLCs) in Saudi Arabia.

Material and Methods

A secondary data analysis was performed on small-cell lung cancers (SCLCs) and Non-small cell lung cancers (NSCLCs) registered in the Saudi Cancer Registry (SCR) for the period 2009-2013 to estimate predictors of mortality for both lung cancer types. A total of 404 cases (197 SCLC and 207 NSCLC) were included in the analysis, all Saudi nationals.

Result

A total of 213 (52.75%) deaths occurred among lung cancer patients, 108 (54.82%) among SCLCs and 105 (50.72%) among NCSLCs. Around 75% of patients were diagnosed with advanced disease stage for both SCLC & NSCLC. Univariate analysis revealed higher mean age at diagnosis in dead patients compared to alive patients for SCLCs (p=0.04); but not NSCLCs, a lower mortality for NSCLCs diagnosed in 2013 (p=0.025) and a significant difference in stage of tumor (p=0.006) and (p=0.035) for both SCLC and NSCLC respectively. In multiple logistic regression, stage of tumor was a strong predictor of mortality, where distant metastasis increased morality by 6-fold (OR=5.87, 95% CI: 2.01 - 17.19) in SCLC and by 3-fold (OR= 3.29, 95% CI: 1.22 - 8.85) in NSCLC, compared to localized tumors. Those with NSCLC who were diagnosed in 2013 were less likely to die by 64% compared to NSCLC diagnosed in 2009 (OR=0.36, 95% CI: 0.14 - 0.93). Age, sex, topography and laterality were not associated with mortality for both cancer types.

Conclusion

We observed that the stage of the tumor is the strongest predictor of mortality for both SCLCs and NSCLs. This confirms the impact of diagnostic stage on survival. Because the majority of lung cancers were diagnosed at an advanced stage, introducing lung cancer screening and early detection in Saudi Arabia will likely confer a survival advantage in lung cancer.

Table of Contents

Table of Content

Chapter 1: Introduction ..…………………………………………………………………. 7

Chapter 2: Literature Review……………………………………………………………. 10

Lung Cancer: Definition, Histology, Grading and Staging

Lung Cancer Incidence, Mortality and Survival

- Global Status

- Status in the Middle East and North Africa Region

- Status in Saudi Arabia

Risk Factors of Lung Cancer

Prognostic Factors for Lung Cancer

Lung Cancer Screening

Problem Statement

Research Questions

Significance

Chapter 3 - Manuscript………………………………………………………………….…25

Abstract

Introduction

Methods

Result

Discussion

Chapter 4 - Conclusion and Recommendations……….…………………………………. 42

References…………………………………………………………………………………… 43

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