Survival Rates and Predictors of Mortality in Lung Cancer: A Multi-Centre Study in Kerala

Background: Lung cancer is a major health problem in India and accounts for 5.9% of all cancers and 8.1% of all cancer-related deaths. Survival analysis studies are scarce in India as they require long-term follow-up and a good database. Therefore, the present study was conducted to understand survival rates and factors associated with lung cancer mortality in India. Methods: It was a hospital-based registry, wherein six hospitals were selected from three zones – north, central, and south zones of Kerala. Patients of pathologically proven primary lung cancer (ICD-11 code C 33 and C 36) were recruited. All patients were followed up for 2 years from the date of diagnosis. Results: A total of 761 patients were registered from six tertiary care hospitals of Kerala who were diagnosed with primary lung cancer during the period 2017–2019. The median survival of the study population was 8.6 months (IQR 2.9–21.6). The cumulative mortality rates at the end of 6 months, 1 year, and 2 years were 39.9%, 57.8%, and 70.2%, respectively. The overall mortality rate was 6.38 (CI 3.03–12.97) per 100 person months. In adjusted Cox-proportional hazard model, participants with lymph node status of N2 (HR = 4.9, 95% CI 1.0–23.6), N3 (HR = 5.9, 95% CI 0.53–66.7), and NX (HR = 31.7, 95% CI 2.8–354.7) had higher mortality risk compared to those with N1 status. Conclusion: This study includes significant implications for policy in cancer diagnosis and first health system contact for treatment. Findings are crucial to effectively stratify risk in lung cancer beyond smoking history, comprehensive identification, and assessment of potential predictors of mortality.