Survival with lung cancer in Finland has not improved during 2007–2019–a single center retrospective population-based real-world study

According to the CONCORD-3 study, the 5-year survival rate of lung cancer patients in Finland has not improved during the twenty-first century. In the present study, we evaluated the survival trends of lung cancer patients diagnosed and treated in one of the five university hospitals in Finland to determine possible explanatory factors behind the lack of improved survival. This retrospective population-based study included all lung cancer patients diagnosed in Tampere University Hospital in 2007–2019 (<i>N</i> = 3041). The study population was divided into two subcohorts: the patients diagnosed in 2007–2012 and those diagnosed in 2013–2019. The two subcohorts were then compared to analyze the temporal changes in survival and the distribution of prognostic factors. A comparison of the patients diagnosed in 2007–2012 and 2013–2019 showed that the patients’ overall survival had remained unchanged. The median overall survival was 8.7 months in the earlier subcohort and 9.2 months in the later subcohort. The respective 5-year survival rates were 16.6% and 17.8%, and these differences were not statistically significant. The proportion of stage IV patients (approximately 59% in both subcohorts) and their risk of death were similar for the two subcohorts. According to the regression analysis, male gender, advanced stage, and poor Eastern Cooperative Oncology Group performance status were independent risk factors for death, while a never-smoking status and mutation-positive disease were associated with a decreased risk of death, but only in the later cohort. Echoing the results of CONCORD-3, this study confirmed that the real-world survival of unselected lung cancer populations in Finland has not improved over the last 15 years, mainly because of the unchanged proportions of patients with late-stage lung cancer. This calls for earlier recognition of lung cancer, achieved by screening and increasing awareness of the disease.

根据CONCORD-3研究结果，芬兰肺癌患者的5年生存率在21世纪内未出现改善。本研究针对芬兰五所大学附属医院之一收治的肺癌患者的生存趋势展开评估，旨在明确生存率未获提升的潜在解释因素。
本项基于人群的回顾性研究纳入了2007年至2019年间于坦佩雷大学附属医院确诊的全部肺癌患者（N=3041）。研究队列被划分为两个亚组：2007-2012年确诊患者与2013-2019年确诊患者，通过对比两组分析生存率及预后因素分布的时序变化。
对2007-2012年与2013-2019年两个亚组的对比分析显示，患者的总生存期未发生显著变化。早期亚组的中位总生存期为8.7个月，晚期亚组则为9.2个月；对应的5年生存率分别为16.6%与17.8%，组间差异无统计学意义。两个亚组的IV期患者占比（两组均约为59%）及其死亡风险均无明显差异。回归分析结果表明，男性性别、晚期分期以及较差的东部肿瘤协作组（Eastern Cooperative Oncology Group）体能状态是死亡的独立危险因素；非吸烟状态与突变阳性疾病均与死亡风险降低相关，但该关联仅在2013-2019年亚组中显著。
本研究与CONCORD-3研究结果一致，证实芬兰未经筛选的肺癌人群的真实世界生存率在过去15年间未获改善，其核心原因为晚期肺癌患者的占比未发生变化。该结果提示，需通过肺癌筛查及提升公众疾病认知度以实现肺癌的早期识别。