Five-year overall survival in lung adenocarcinoma: Real-world results from three French nationwide cohorts (2000–2010–2020).

Abstract

8600 Background: Long-term (5-year) real-world overall survival (OS) in non–small cell lung cancer (NSCLC) remains poorly documented especially in prospective condition. The French nationwide KBP program comprises prospective cohorts conducted every 10 years since 2000 to evaluate lung cancer prognosis. In 2020, 8,941 patients were included across 81 non-academic public hospitals, with lung adenocarcinoma (LA) representing the most frequent histologic subtype. Building on previously reported 3-year survival results[1], we assessed temporal changes in 5-year OS and described the characteristics of long-term survivors with LC using the 2000, 2010, and 2020 cohorts. Methods: Patients with lung cancer, all stages, diagnosed in non-academic public hospitals in 2000, 2010, and 2020 were included in the French nationwide KBP cohorts, all conducted using the same prospective methodology. For the 2020 cohort, patient inclusion occurred between 1 January and 31 December 2020. Vital status was collected during follow-up. Five-year OS was estimated using the Kaplan–Meier method and compared across the 2000, 2010, and 2020 cohorts, overall and stratified by stage at diagnosis. In the 2020 cohort, a descriptive comparative analysis was performed between long-term survivors (≥5 years) and patients who died before this term. In the 2020 cohort, multivariable Cox proportional hazards models are ongoing to identify prognostic factors associated with OS. Prespecified covariates include age, sex, ECOG PS, smoking status, stage at diagnosis. These analyses remain preliminary and will be updated for the conference, as the 5-year vital status follow-up has recently been completed. Results: Among the 1,640, 3,199, and 5,009 patients with LA included in the 2000, 2010, and 2020 KBP cohorts, respectively, 5-year vital status was available for 99.3%, 96.2%, and 83.4% of patients. 5-year OS was 29.4% (95% CI, 28.1–30.7) in 2020, compared with 14.4% (95% CI, 13.3–15.7) in 2010 and 4.7% (95% CI, 3.0–7.2) in 2000, corresponding to an absolute improvement of 15.0% over the last decade. In the 2020 cohort, long-term survivors (≥5 years; n = 772) were 47.8% female, only six patients had an ECOG performance status ≥3, 48.2% were current smokers, 19.8% never-smokers and 32.0% former smokers. The distribution of stage at diagnosis among long-term survivors was 37.6% stage I, 9.9% stage II, 20.9% stage III, and 31.6% stage IV. Conclusions: 5-year real-world OS in LA has markedly improved over the last two decades with an increasing proportion of long-term survivors. Ongoing stage-stratified and multivariable analyses will further characterize long-term survival patterns. [1] https://evidence.nejm.org/doi/full/10.1056/EVIDoa2400443.