Epidemiologic and prognostic factors for lung cancer in a county hospital

This is a study of 269 patients with lung cancer at the Erie County Medical Center who were admitted between 1973 and 1978. They were analyzed for sex, race, age, history of smoking, occupation, tumor cell type, cytology, incidence of metastases, changes in liver function, mode of treatment, and survival. The incidence of cancer was highest in white males. Only 1.5% of patients were under age 40. Smoking was a predisposing factor. Not enough information was available to determine the relationship of occupation to lung cancer. Squamous cell carcinoma was the most common (53.9%), followed by adenocarcinoma (16.0%) and small-cell carcinoma (12.6%). Sputum cytology was 28.3% sensitive, and bronchial washings were 52.2% sensitive. A greater incidence of bone metastases from a small-cell primary (50%) was found than is reported in the literature. Changes in SGOT and/or SGPT liver enzymes correlated significantly with liver metastases, but not with tumor cell type. Changes in alkaline phosphatase correlated well with bone metastases. Radiation was the most commonly used mode of therapy. The best survival was achieved in patients treated by surgery (22.6 months), followed by surgery and radiation (16.2 months); those treated by radiation alone had a mean survival time of 8.7 months. Untreated patients had a mean survival time of 2.4 months. Treated patients with adenocarcinomas had the longest survival (18.5 months), compared to 13.0 months for those with squamous cell carcinomas and 8.4 months for those with small-cell carcinomas. Only three patients survived 5 years, all of whom were treated surgically for adenocarcinoma. No patients with tumors of other cell types survived 5 years. The 5-year survival rates are 2.1% (3 of 141) for all histologic types of lung cancer and 12.5% (3 of 24) for adenocarcinoma.