The relationship between risk factors and histology in lung cancer Turkish Thoracic Society Lung and Pleural Malignancies Study Group The map of lung cancer in Turkey
Dec 30, 2015
The relationship between risk factors
and histology in lung cancer
Turkish Thoracic Society Lung and Pleural Malignancies Study Group
The map of lung cancer in Turkey
9 provinces, 25 centers, 105 investigators
Method
• Analysis of data of “The project of the map of lung cancer in Turkey”
• The aim of the study was to investigate the relationship between risk factors and histology in lung cancer
• The project of the map of lung cancer in Turkey– The patient diagnosed as primary lung cancer between
01.01.2005 and 31.12.2005– 9 provinces, 25 centers, 105 investigators
• The provinces of incidence: İzmir, Bursa, Trabzon, Erzurum, Sivas, Diyarbakır, Antalya
• Ankara, İstanbul
İzmir M: 57.3F: 6.2
Age-standardised incidence rates
SivasM: 38.7F: 6.6
TrabzonM: 48.9F: 4.1
ErzurumM: 36.5F: 5.2
DiyarbakırM: 13.7F: 2.1
AntalyaM: 25.8F: 3.4
BursaM: 35.5F: 3.5
Total: M: 41.7 F: 4.8 n/100.000
Histological types
N %Squamous 2145 29.4
Adeno 1263 17.3
(BAC) 40 0.6
Large cell 116 1.6
Adenosquamous 24 0.3
NSCLC, unspecified 1681 23.0
Small cell 1129 15.5
Sarcomatoid carcinoma
24 0.3
Carcinoid 35 0.5
Salivary gland-type 5 0.07
Other 874 12.0
NSCLC
5259
71.9%
Risk factors
Cigarette smoking 91.5%
Environmental asbestos exposure
11.6%
Lung cancer in family 9.6%
Fibrotic scar due to TB 7.0%
Tumor close to the scar 2.8%
COPD 21.6%
Connective tissue diseases 0.2%
IPF 0.3%
Yaşa spesifik insidans hızı, erkek
0
50
100
150
200
250
300
350
0-4
5-9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
4
85 +
Age-specific incidence rate
Male
n/100.000
Age-specific incidence rate
Yaşa spesifik insidans hızı, kadın
05
101520253035404550
0-4
5-9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
4
85 +
Femalen/100.000
Sex & Age
•Total 7303 cases
•Sex Male: 90.5% Female: 9.5%
• Age
•All group: Mean: 60.7 + 10.7 (21 -105)
•Male
•Mean: 60.7 + 10.5
•Peak value of incidence: 70-74 300/100.000
•Kadın
•Mean : 60.9 + 12.5
•Peak value of incidence: 80-84 45/100.000
Age groups & Histological types
P<0.01
Large Small Squamous Adeno TotalLarge Small Squamous Adeno Total
Total
14 73 93 110 290
4,8% 25,2% 32,1% 37,9% 100,0%
101 1033 2003 1132 4269
2,4% 24,2% 46,9% 26,5% 100,0%
115 1106 2096 1242 4559
2,5% 24,3% 46,0% 27,2% 100,0%
% sira icinde
% sira icinde
% sira icinde
44 ve alti
45 ve uzeri
Toplam
Buyuk h Kucuk h Skuamoz Adeno
Histolojik Gruplar
Toplam
P<0.01
Age groups & Histological types
Large Small Squamous Adeno Total
45 age ↑
45 age ↓
Total
Large cell Small cell Squamous Adeno Total
Male 104
2.5%
1030
24.4%
2065
48.9%
1020
24.2%
4219
100%
Female 12
2.8%
99
22.8%
80
18.4%
243
56.0%
434
100%
Sex & Histological types
9 165 307 218 699
1,3% 23,6% 43,9% 31,2% 100,0%
17 66 118 69 270
6,3% 24,4% 43,7% 25,6% 100,0%
19 232 373 213 837
2,3% 27,7% 44,6% 25,4% 100,0%
2 14 15 7 38
5,3% 36,8% 39,5% 18,4% 100,0%
3 38 73 17 131
2,3% 29,0% 55,7% 13,0% 100,0%
19 235 606 243 1103
1,7% 21,3% 54,9% 22,0% 100,0%
34 320 500 414 1268
2,7% 25,2% 39,4% 32,6% 100,0%
2 11 44 11 68
2,9% 16,2% 64,7% 16,2% 100,0%
11 48 109 71 239
4,6% 20,1% 45,6% 29,7% 100,0%
116 1129 2145 1263 4653
2,5% 24,3% 46,1% 27,1% 100,0%
Ankara
Antalya
Bursa
Diyarbakir
Erzurum
Istanbul
Izmir
Sivas
Trabzon
Toplam
Büyükhücreli
Küçükhücreli Skuamoz Adeno ca Toplam
Provinces & Histological types
Large Small Squamous Adeno Total
Total
Large cell Small cell Squamous Adeno Total
Non-smoker
9
3.1%
43
14.6%
46
15.6%
197
66.8%
295
100%
Smoker 84
2.4%
847
24.3%
1726 49.6%
822
23.6%
3479
100%
Smoking & Histological types
Large cell Small cell Squamous Adeno
Non-smoker
9
9.7%
43
4.8%
46
2.6%197
19.3%
Smoker 84
90.3%
847
95.2%
1726 97.4%
822
80.7%
Total 93
100%
890
100%
1772
100%
1019
100%
Smoking & Histological typesN Packet year (Mean)
Large cell 21 40.9
Small cell 160 53.1
Squamous 465 52.2
Adeno 219 42.5
Total 865 49.6
Comparison according to packet year
Large cell Small cell Squamous Adeno Total
Non-smoker
8
3.4%
34
14.7%
40
17.2%
150
64.7%
232
100%
Passive smoker
1
1.6%
9
14.3%
6
9.5%
47
74.6%
63
100%
Passive smoking & Histological types
P=0.00
Smoking & Histological types filter & no filter
Filter
No-filter
P=0.00
No
Yes
Smoking & Histological types Roller tobacco
Total
%Sivas 43.6
Diyarbakır 28.3
Ankara 24.1
İzmir 11.9
İstanbul 11.4
Antalya 11.1
Trabzon 3.5
Bursa 0.7
Erzurum 0.0
Environmental asbestos exposure
Exposure Large cell Small cell Squamous Adeno Total
No 72
2.4%
729
23.9%
1432
47.0%
814
26.7%
3047
100%
Yes 16
2.9%
125
23.0%
260
47.9%
142
26.2%
543
100%
Environmental asbestos exposure &
Histological types
COPD Large cell Small cell Squamous Adeno Total
No 67
2.4%
663
24.7%
1217
44.2%
797
29.1%
2739
100%
Yes 22
2.4%
204
22.0%
507
54.7%
194
20.9%
927
100%
COPD & Histological types
Fibrotic scar
Large cell Small cell Squamous Adeno Total
No 74
2.4%
751
24.2%
1436
46.3%
838
27.0%
3099
100%
Yes 8
2.5%
51
15.9%
181
56.6%
80
25.0%
320
100%
Fibrotic scar due to TB & Histological types
Tumor close to the scar
4
3.3%
16
13.1%
68
55.7%
34
27.9%
320
100%
Heating systems & Histological types
Heating Large cell Small cell Squamous Adeno Total
Stove/ fireplace
65
2.4%
639
23.4%
1341
49.0%
689
25.2%
2734
100%
Other 14
2.4%
151
25.5%
236
39.9%
191
32.3%
592
100%
P=0.113
Previous cancer & Histological types
Previous cancer No
Yes
Total
Large Small Squamous Adeno Total
P=0.018
Lung cancer in family & Histological types
L.cancer in family No
Yes
Un-known
Total
Large Small Squamous Adeno Total
RESULTS-1
• Squamous cell is the most frequent type
• Adenocancer is the most frequent type below– Younger patients– Females– Non.smokers– Passive smokers
• Adenocancer– 80% of them are smokers; there is a relationship with smoking– By changing smoking style, adenocancer increasing
• More developed cities and young people – Adenocancer may be first type in next 20 years in Turkey
RESULTS-2
• There is no influence asbestos exposure on histological type
• Adenocancer is not the most common type among patients with fibrotic scar due to TB
• Indoor smoke increases risk of squamous type; while decreasing indoor smoke risk, adenocancer increasing
• Cancer history increases risk of adenocancer– Genetic susceptibility & adenocancer?