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Non-Small Cell Lung Cancer

Prognosis

Edward S. Kim, MD, MBA, FACP, FASCO 
Reviewed on December 04, 2024
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Prognostic Factors

The most important prognostic factor for lung cancer survival is cancer stage:

  • Patients with Stage I disease have a 2-year overall survival (OS) of 90-97% and a 5-year OS of 77-92%.
  • Patients with Stage II cancer show a 2-year OS of 72-87% and a 5-year OS of 53-68%.
  • With Stage IIIA disease, the 5-year OS is 36-41%, while it is 24-26% with Stage IIIB disease and 12-13% with Stage IIIC disease.
  • With metastatic disease, the median OS used to be ~12 months; the advent of targeted therapy and immunotherapy has extended the OS in these patients to 20-38.6 months, depending on biomarkers and treatment choices.

Beyond cancer stage, the most important prognostic factors are patient and tumor characteristics that influence the choice of therapy. Relevant tumor characteristics include genetic mutations (e.g., in Epidermal Growth Factor Receptor (EGFR)-positive Stage IV cancer, osimertinib treatment extends median survival to 38.6 months), biomarkers (e.g., patients with Stage IV…

Prognostic Factors

The most important prognostic factor for lung cancer survival is cancer stage:

  • Patients with Stage I disease have a 2-year overall survival (OS) of 90-97% and a 5-year OS of 77-92%.
  • Patients with Stage II cancer show a 2-year OS of 72-87% and a 5-year OS of 53-68%.
  • With Stage IIIA disease, the 5-year OS is 36-41%, while it is 24-26% with Stage IIIB disease and 12-13% with Stage IIIC disease.
  • With metastatic disease, the median OS used to be ~12 months; the advent of targeted therapy and immunotherapy has extended the OS in these patients to 20-38.6 months, depending on biomarkers and treatment choices.

Beyond cancer stage, the most important prognostic factors are patient and tumor characteristics that influence the choice of therapy. Relevant tumor characteristics include genetic mutations (e.g., in Epidermal Growth Factor Receptor (EGFR)-positive Stage IV cancer, osimertinib treatment extends median survival to 38.6 months), biomarkers (e.g., patients with Stage IV cancer with PD-L1 expression on ≥50% of cells show a longer OS when treated with PD-L1 inhibitors compared to patients with tumors with PD-L1 expression on ≥1% cells), and histological (sub)type (e.g., lepidic adenocarcinoma and solid adenocarcinoma have, respectively, an excellent and a poor prognosis). The most important patient factor is their performance status, since patients with good performance status can typically tolerate more aggressive treatment and tend to have better outcomes regardless of cancer Stage.

References

  • Cabanero M, Prodipto P, Ming-Sound T. Histology and Molecular Testing. In: Gillaspie EA, Cass AS, Horn L, eds. Lung Cancer: An Evidence-Based Approach to Multidisciplinary Management. Elsevier; 2024.
  • Cancer Staging Systems. ACS. https://www.facs.org/quality-programs/cancer-programs/american-joint-committee-on-cancer/cancer-staging-systems/. Accessed October 19, 2024.
  • Choi HK, Ghobrial M, Mazzone PJ. Models to Estimate the Probability of Malignancy in Patients with Pulmonary Nodules. Ann Am Thorac Soc. 2018;15(10):1117-1126.
  • Fathi JT, Kathuria H. Tobacco Prevalence and Treatment. In: MacRosty CR, Rivera MP, eds. Lung Cancer: A Comprehensive Guide for the Clinician. Humana Press, an imprint of Springer Nature Switzerland; 2023.
  • Ghosh S, Marshall T, Baltaji S. Staging and Diagnosis of Lung Cancer. In: MacRosty CR, Rivera MP, eds. Lung Cancer: A Comprehensive Guide for the Clinician. Humana Press, an imprint of Springer Nature Switzerland; 2023.
  • Hendriks LEL, Remon J, Faivre-Finn C, et al. Non-small-cell lung cancer. Nat Rev Dis Primers. 2024;10(1):71.
  • Kitazawa S, Gregor A, Yasufuku K. Treatment of Stage III Non-small Cell Lung Cancer. In: MacRosty CR, Rivera MP, eds. Lung Cancer: A Comprehensive Guide for the Clinician. Humana Press, an imprint of Springer Nature Switzerland; 2023.
  • Lababede O, Meziane MA. The Eighth Edition of TNM Staging of Lung Cancer: Reference Chart and Diagrams. Oncologist. 2018;23(7):844-848.
  • National Cancer Institute. Cancer of the Lung and Bronchus - Cancer Stat Facts. https://seer.cancer.gov/statfacts/html/lungb.html. Accessed: October 19, 2024.
  • Pannu J, Holden VK, Revelo A, Ghattas C, Murthy V. Lung Cancer: Diagnostic Techniques. In: Gillaspie EA, Cass AS, Horn L, eds. Lung Cancer: An Evidence-Based Approach to Multidisciplinary Management. Elsevier; 2024.
  • Sun TY, Das M. Treatment of Stage IV Non-small Cell Lung Cancer. In: MacRosty CR, Rivera MP, eds. Lung Cancer: A Comprehensive Guide for the Clinician. Humana Press, an imprint of Springer Nature Switzerland; 2023.
  • Tasoudis P, Weiner AA, Mody, GN. Treatment of Early-Stage (Stage I and II) Non-Small Cell Lung Cancer. In: MacRosty CR, Rivera MP, eds. Lung Cancer: A Comprehensive Guide for the Clinician. Humana Press, an imprint of Springer Nature Switzerland; 2023.
  • Vedachalam S, Tanner NT, Sears CR. Approach to Lung Nodules. In: MacRosty CR, Rivera MP, eds. Lung Cancer: A Comprehensive Guide for the Clinician. Humana Press, an imprint of Springer Nature Switzerland; 2023.
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