The natural five-year course in bronchial carcinoma. Epidemiologic results

A series of 273 unselected patients with bronchial carcinoma, comprising a total prospective 5-year study from a Swedish county with an observed 5-year survival of 7.0%, is presented. The autopsy rate in deceased patients was 94%. All diagnoses were histologically or cytologically verified. The 5-year survival rates for squamous cell carcinoma, small cell carcinoma, adenocarcinoma, and large cell carcinoma were 7.5%, 0%, 11.7%, and 3.8%, respectively. In 73% of all survivors, and in all survivors of adenocarcinoma, the disease was discovered by accident. It is concluded that the intensified search for bronchial carcinoma on chest x-rays taken because of suspicion of other diseases may have contributed to the observed survival gains as compared with other studies. The observed "real" 5-year survival rate, with inclusion, as "survivors," of patients dying of other diseases without remaining bronchial carcinoma at autopsy was 8.8%. The corresponding Kaplan-Meier product limit estimated 5-year survival was 7.7%. The study is considered to reflect as well as possible the natural 5-year course of the disease and the results cannot be repeated because of the new therapeutic possibilities introduced during the last years.