Ten-year follow-up of a province-wide cohort of surgical lung cancer patients in Nova Scotia

Background: After a diagnosis of lung carcinoma, survival is poor for all patients. We sought to assess 10-year survival and predictors of outcome after surgery for lung cancer in Nova Scotia. Methods: We identified all patients (n = 130) undergoing resection for lung cancer in Nova Scotia in 1994 from the Nova Scotia Cancer Registry and hospital charts and followed them prospectively for 10 years. We used Cox proportional hazards modelling to identify predictors of survival. Results: The patients' mean age at operation was 67.7 (standard deviation [SD] 8.2) years, and 70% of the patients were men. Most of the operations (n = 80, 61.5%) were performed in Halifax, and adenocarcinoma (n = 55, 42.3%) was the most common histologic type. At the time of surgery, 66.9% of the cases were stage 1, 20.0% were stage 2 and 13.1% were stage 3. Survival at 5 and 10 years was 34% and 13%, respectively. Age of 70 years or older (hazard ratio [HR] 1.79, 95% confidence interval [CI] 1.20-2.68), large cell carcinoma (HR 2.27, 95% CI 1.31-3.94) and stage 3 cancer (HR 2.21, 95% CI 1.25-3.90) were significant independent predictors of survival. Hospital site was not associated with any difference in survival (p = 0.66), although there was a trend toward differential rates of lymph node sampling across sites (p = 0.06). The presence of node sampling was associated with improved survival in a separate multivariate model (HR 0.51, 95% CI 0.29-0.89). Conclusion: Actuarial survival after resection of lung carcinoma in Nova Scotia in 1994 was 34% at 5 years and 13% after 10 years. Age, stage and histology are independent predictors of survival; lymph node sampling was associated with greater survival.