Early mortality in real-life nationwide epidemiological study on lung cancer in nonacademic French public hospitals

ABSTRACT

Background: Each decade since 2000, the French College of General Hospital Pulmonologists (CPHG) conducts a real-life nationwide prospective epidemiological, observational, multicenter study on lung cancer (LC). In 2020, the CPHG constituted the third cohort, KBP-2020-CPHG. We reported here the data on one-month and three-month mortality among general population of this cohort and compared them with 2010 cohort. Methods: Collection of all consecutive LC histologically or cytologically confirmed between 01/01 and 12/31/2020 in non-academic public hospital pulmonology or oncology units in France. A Scientific Committee controlled inclusion exhaustivity and quality in each center. Results: 82 centers collected 8,999 patients in 2020. One-month mortality was 8.8% (734/8,999) and 9.7% (680/7,051) in 2010. Three-month mortality was 21.5% (1,771/8,999) in 2020 and 23.3% (1,624/7,051) in 2010 (Table 1). According to sex, mortality at one and three months mainly affected men (525/734;71.5% and 1,259/1,771;71.1% respectively). Mean age at diagnosis was older than in the cohort population (67.8 y-o);respectively 69.9 and 69.8 at one and three months. At diagnosis, patients were in poorer ECOG mainly grade 2 (211/697;30.3%) or 3 (194/697;27.8%) for one-month and mainly grade 1 (549/1,703;32.2%) or 2 (547/1,703;32.1%) for three-month mortality. Among ECOG grade 3 and 4, 34.8% (194/557) and 57.1% (93/163) were dead at one month respectively;63.5% (350/551) and 83.4% (136/163) respectively were dead at three months. According to histology, adenocarcinoma was the most common (308/734;42%), followed by small cell lung cancer (170/734;23.2%) at one-month;adenocarcinoma was also the most common (822/ 1,771;46.4%), followed by squamous cell carcinoma (380/1771;21.5%) at three-month mortality. Most patients who died early were stage 4, metastatic/disseminated (respectively 625/702;89% and 1,488/1,715;86.8% for one- and three-month mortality). In patients with COVID19 infection (n=547), mortality at one and three months was respectively 36.4% (174/478) and 46.7% (228/ 488). Conclusions: Early mortality has not improved over the two decades and remains high. KBP- 2020-CPHG study was performed during COVID-19 pandemic, which may have generated delays in diagnosis and limited access to care and hospital. Early mortality at one and three months concerned mostly men, mean age nearly 70 y-o, adenocarcinoma, metastatic disease and frail patients. This confirms the potential value of LC screening program in a targeted population.