The changing landscape of stage-at-presentation in lung cancer in the United States: Long-term data from SEER database

Lung cancer is a global problem with an increasing incidence worldwide. Efforts have been made to adopt screening programs that can lead to earlier diagnosis. However, little is known about the resulting changes in disease distribution. Small and non-small cell lung cancer cases between 2004 and 2019 were extracted using the SEER database [17 reg; Nov 2021 sub]. We excluded patients with unknown/unreported stages in stage trend analysis. We further performed an exploratory analysis using the year 2013, when the American Cancer Society issued its first recommendation for lung cancer CT screening with patients, to explore potential associations between screening and change in stage at presentation. We analyzed data from 660 532 lung cancer patients (non-small cell lung cancer [86.8%, n = 573 139]; small cell lung cancer [13.2%, n = 87 393]). Most cases were presented with the distant disease at initial presentation (54.9%, n = 362 733). Longitudinal tracking of the distribution of cases among different disease stages showed an increase in the proportion of patients diagnosed with the localized disease compared to patients diagnosed with a regional disease or those with distant spread with an increased median overall survival over time (table). Compared to patients diagnosed before 2013, patients diagnosed after 2013 had a statistically significant higher likelihood of presenting with a localized disease stage (24.1% vs. 19.2%, p = 0.001) and longer median overall survival (14 months vs. 10 months, p = 0.001). There is an increase in the proportion of lung cancer cases presenting with localized disease stages with improved overall survival. This can probably be partially attributed to efforts made to implement wide screening programs.