Risk Factors for Lung Cancer Mortality in a Referral Center

  • Jamaati, H (Chronic Respiratory Diseases Research Center) ;
  • Baghaei, P (Clinical Tuberculosis and Epidemiology Research Center) ;
  • Sharifianfard, M (Chronic Respiratory Diseases Research Center) ;
  • Emami, H (Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences) ;
  • Najmi, K (Chronic Respiratory Diseases Research Center) ;
  • Seifi, S (Chronic Respiratory Diseases Research Center) ;
  • Salimi, B (Chronic Respiratory Diseases Research Center) ;
  • Pourabdollah, M (Chronic Respiratory Diseases Research Center) ;
  • Kiani, A (Chronic Respiratory Diseases Research Center) ;
  • Hashemian, M (Chronic Respiratory Diseases Research Center) ;
  • Khosravi, A (Chronic Respiratory Diseases Research Center)
  • Published : 2016.06.01


Background: Lung cancer is one of the most common causes of death that is rising in many countries including Iran. This study aimed to determine the impact of factors on survival of lung cancer patients at a referral center of lung diseases in Tehran, Iran. Materials and Methods: A retrospective study was conducted on adult lung cancer cases admitted to a referral center for lung diseases from 2011 to 2015. Multivariate analysis was performed to determine the risk factors for all-cause mortality. Results: Of a total 933 patients with lung cancer, 53.4% died, 49.3% of them at the hospital. Overall median follow-up time was 7 months. The most common histological type of cancer was adenocarcinoma with a 13 month median survival time. Age ${\geq}55$ and smoking remained significant for all-cause mortality on Cox analysis, whereas gender was not. Conclusions: The survival of lung cancer patients is poor and the patients with history of smoking and age${\geq}55$ are at increased risk of death. Having a large hospital-based registry provides a good measurement of prognostic statistics for lung cancer. Further investigations are necessary to establish reasons for mortality.


  1. Alexiou C, Onyeaka CV, Beggs D, et al (2002). Do women live longer following lung resection for carcinoma? Eur J Cardiothorac Surg, 21, 319-25. https://doi.org/10.1016/S1010-7940(01)01114-9
  2. Asamura H, Goya T, Koshiishi Y, et al (2008). A Japanese Lung Cancer Registry study: prognosis of 13,010 resected lung cancers. J Thorac Oncol, 3, 46-52. https://doi.org/10.1097/JTO.0b013e31815e8577
  3. Bach PB, Kattan MW, Thornquist MD, et al (2003). Variations in lung cancer risk among smokers. J Natl Cancer Inst, 95, 470-8. https://doi.org/10.1093/jnci/95.6.470
  4. Bilello KS, Murin S, Matthay RA (2002). Epidemiology, etiology, and prevention of lung cancer. Clin Chest Med, 23, 1-25. https://doi.org/10.1016/S0272-5231(03)00057-1
  5. Chansky K, Sculier JP, Crowley JJ, et al (2009). The International Association for the Study of Lung Cancer Staging Project: prognostic factors and pathologic TNM stage in surgically managed non-small cell lung cancer. J Thorac Oncol, 4, 792-801. https://doi.org/10.1097/JTO.0b013e3181a7716e
  6. Fu JB, Kau TY, Severson RK, et al (2005). Lung cancer in women: analysis of the national Surveillance, Epidemiology, and End Results database. Chest, 127, 768-77. https://doi.org/10.1378/chest.127.3.768
  7. Hajmanoochehri F, Mohammadi N, Zohal MA, et al (2014). Epidemiological and clinicopathological characteristics of lung cancer in a teaching hospital in Iran. Asian Pac J Cancer Prev, 15, 2495-500. https://doi.org/10.7314/APJCP.2014.15.6.2495
  8. Janssen-Heijnen ML, Coebergh JW (2001). Trends in incidence and prognosis of the histological subtypes of lung cancer in north america, australia, New Zealand and Europe. Lung Cancer, 31, 123-37. https://doi.org/10.1016/S0169-5002(00)00197-5
  9. Jemal A, Clegg LX, Ward E, et al (2004). Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival. Cancer, 101, 3-27. https://doi.org/10.1002/cncr.20288
  10. Kefeli U, Kaya S, Ustaalioglu BO, et al (2011). Prognostic factors in elderly patients with non-small cell lung cancer: a two-center experience. Med Oncol, 28, 661-6. https://doi.org/10.1007/s12032-010-9504-5
  11. Lam WK, White NW, Chan-Yeung MM (2004). Lung cancer epidemiology and risk factors in Asia and Africa. Int J Tuberc Lung Dis, 8, 1045-57.
  12. Lewtas J (2007). Air pollution combustion emissions: characterization of causative agents and mechanisms associated with cancer, reproductive, and cardiovascular effects. Mutat Res, 636, 95-133. https://doi.org/10.1016/j.mrrev.2007.08.003
  13. Luqman M, Javed MM, Daud S, et al (2014). Risk factors for lung cancer in the Pakistani population. Asian Pac J Cancer Prev, 15, 3035-9. https://doi.org/10.7314/APJCP.2014.15.7.3035
  14. Mousavi SM, Gouya MM, Ramazani R, et al (2009). Cancer incidence and mortality in Iran. Ann Oncol, 20, 556-63.
  15. Najafi F, Jafari R, Mozafari HR, Leghaei Z (2010). Trend in lung cancer incidence in Kermanshah province -Iran. Behbood, 14, 342-48.
  16. Parkin DM, Bray F, Ferlay J, et al (2005). Global cancer statistics, 2002. CA Cancer J Clin, 55, 74-108. https://doi.org/10.3322/canjclin.55.2.74
  17. Puri V, Garg N, Engelhardt EE, et al (2010). Tumor location is not an independent prognostic factor in early stage non-small cell lung cancer. Ann Thorac Surg, 89, 1053-9. https://doi.org/10.1016/j.athoracsur.2010.01.020
  18. Sobin LH GM, Wittekind C, eds. (2010). TNM classification of malignant tumors, 7th ed, Chichester, Wiley
  19. Stewart B, Wild, C.P. (2014). World cancer report 2014. world health organization.
  20. Tammemagi MC, Katki HA, Hocking WG, et al (2013). Selection criteria for lung-cancer screening. N Engl J Med, 368, 728-36. https://doi.org/10.1056/NEJMoa1211776
  21. Travis WD, Brambilla E, Nicholson AG, et al (2015). The 2015 world health organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol, 10, 1243-60. https://doi.org/10.1097/JTO.0000000000000630
  22. Wang BY, Huang JY, Cheng CY, et al (2013). Lung cancer and prognosis in taiwan: a population-based cancer registry. J Thorac Oncol, 8, 1128-35. https://doi.org/10.1097/JTO.0b013e31829ceba4
  23. Wille MM, Dirksen A, Ashraf H, et al (2016a). Results of the randomized danish lung cancer screening trial with focus on high-risk profiling. Am J Respir Crit Care Med, 193, 542-51. https://doi.org/10.1164/rccm.201505-1040OC
  24. Wille MM, Thomsen LH, Petersen J, et al (2016b). Visual assessment of early emphysema and interstitial abnormalities on CT is useful in lung cancer risk analysis. Eur Radiol, 26, 487-94. https://doi.org/10.1007/s00330-015-3826-9
  25. Youlden DR, Cramb SM, Baade PD (2008). The international epidemiology of lung cancer: geographical distribution and secular trends. J Thorac Oncol, 3, 819-31. https://doi.org/10.1097/JTO.0b013e31818020eb
  26. Zahir ST, Mirtalebi M (2012). Survival of patients with lung cancer, Yazd, Iran. Asian Pac J Cancer Prev, 13, 4387-91. https://doi.org/10.7314/APJCP.2012.13.9.4387
  27. Zendehde K SZ, Hassanloo J, Nahvijou A (2011). Audit of a nationwide pathology-based cancer registry in Iran. Basic Clin Cancer Res, 2, 7-13.