Lung cancer in Teesside (UK) and Varese (Italy): a comparison ofmanagement and survival

http://thorax.bmj.com/cgi/content/abstract/61/3/232
Lung cancer in Teesside (UK) and Varese (Italy): a comparison of
management and survival

Published Online First: 11 November 2005. doi:10.1136/thx.2005.040477
Thorax 2006;61:232-239
BMJ Publishing Group Ltd & British Thoracic Society

LUNG CANCER
Lung cancer in Teesside (UK) and Varese (Italy): a comparison of
management and survival
A Imperatori1, R N Harrison2, D N Leitch2, F Rovera1, G Lepore3, G
Dionigi1, P Sutton2, L Dominioni1

1 Center for Thoracic Surgery, University of Insubria, Varese, Italy
2 Department of Respiratory Medicine, University Hospitals of North Tees
and Hartlepool, North Tees and Hartlepool NHS Trust, Hardwick, Stockton on
Tees TS19 8PE, UK
3 Department of Respiratory Medicine, Ospedale S Antonio Abate, Gallarate,
Italy

Correspondence to:
Correspondence to:
Dr A Imperatori
Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo,
Viale Borri 57, 21100 Varese, Italy; andrea.imperatori{at}uninsubria.it

Background: The survival of lung cancer patients in the UK is lower than
in other similar European countries. The reasons for this are unclear.

Methods: Two areas were selected with a similar incidence of lung cancer:
Teesside in Northern England and Varese in Northern Italy. Data were
collected prospectively on all new cases of lung cancer diagnosed in the
year 2000. Comparisons were made of basic demographic characteristics,
management, and survival.

Results: There were 268 cases of lung cancer in Teesside and 243 in
Varese. Patients in Teesside were older (p<0.05), were more likely to have
smoked (p<0.001), had a higher occupational risk (p<0.001), higher
co-morbidity (p<0.05), and poorer performance status (p<0.001).

Fewer patients in Teesside presented as an incidental finding (p<0.001)
and the histological confirmation rate was lower than in Varese (p<0.01).
In Teesside there were more large cell carcinomas (p<0.001), more small
cell carcinomas (p<0.05), and fewer early stage non-small cell lung
cancers (p<0.05).

The resection rate was lower in Teesside (7% v 24%; p<0.01) and more
patients received no specific anti-cancer treatment (50% v 25%; p<0.001).
Overall 3 year survival was lower in Teesside (7% v 14%; p<0.001).
Surgical resection was the strongest multivariate survival predictor in
Varese (HR = 0.46) and Teesside (HR = 0.31). Co-morbidity in Teesside
resulted in a significantly lower resection rate (p<0.001).

Conclusions: Patients with lung cancer in Teesside presented at a later
stage, with more aggressive types of tumour, and had higher co-morbidity
than patients in Varese. As a result, the resection rate was significantly
lower and survival was worse.

Abbreviations: NSCLC, non-small cell lung cancer; SCLC, small cell lung
cancer