Evolution of overall survival (OS) in patients (pts) with incident NSCLC in Denmark and Sweden: A SCAN-LEAF study analysis from the I-O Optimise initiative
Authors: J.B. Sørensen, S. Ekman, O.T. Brustugun, P. Horvat, D. Patel, M. Rosenlund, A. Mette Kejs, A. Juarez-Garcia, M. Daumont, L. Lacoin, J.R. Penrod, J.C. O’Donnell, M. Planck
Journal: Annals of Oncology (2019)

Background: As part of I-O Optimise, a multinational research platform providing real-world insights into the management of lung cancers, the SCAN-LEAF study aims to describe the epidemiology, clinical care, and outcomes for pts with NSCLC in Scandinavia. Here, we report temporal OS trends among pts diagnosed with incident NSCLC from 2005 to 2015 in Denmark and Sweden. Methods: The SCAN-LEAF Danish and Swedish cohorts were established by linking respective national registries and include all adult pts diagnosed with incident NSCLC from Jan 2005 to Dec 2015 (follow-up to Dec 2016). The Kaplan–Meier method was used to estimate OS at 1, 3, and 5 yrs by histology (non-squamous cell [NSQ] or squamous cell [SQ]), TNM stage, and yr of diagnosis; changes in OS over time were assessed using the Cochrane–Armitage test. Results: 31,939 pts in Denmark and 30,067 pts in Sweden were diagnosed with NSCLC from 2005 to 2015. Most were diagnosed at stage IV (51.6% and 48.4%, respectively) and had NSQ histology (54.4% and 60.4%). Statistically significant trends (P < 0.05) for improved OS accompanied by an absolute OS rate increase of > 5% over the analysis period were seen for NSQ pts at 1 yr for all stages in both countries (Table); at 3 yrs for stages I–IIIB in Denmark (P ≤ 0.027), and stages I–II (P ≤ 0.0013) in Sweden; and at 5 yrs for stages I–II (P ≤ 0.026) in both countries. For SQ pts, this was seen only at 1 yr for stage IIIA in Denmark and stage I in Sweden (Table), and at 5 yrs for stage IIIA in Denmark (p = 0.02).Table46P1-yr survival probability*Includes only patients with valid TNM staging classification at diagnosis. TNM, tumour, nodes, and metastasis.Year of DiagnosisP value for trend20052006200720082009201020112012201320142015DENMARKNSQ (n = 16,535)Stage I82%85%88%92%91%91%92%93%92%91%92%0.0001Stage II77%80%79%77%72%86%80%88%84%88%83%0.007Stage IIIA67%71%76%57%67%69%72%74%74%70%75%0.017Stage IIIB43%46%41%41%36%49%53%50%47%47%51%0.032Stage IV23%25%21%23%24%24%25%26%27%27%31%<0.0001SQ (n = 7987)Stage I80%79%82%79%85%85%87%85%83%86%83%0.114Stage II68%59%71%74%73%60%69%77%74%67%72%0.276Stage IIIA42%55%57%50%58%57%62%62%59%59%57%0.014Stage IIIB32%39%38%38%31%40%41%45%38%43%42%0.060Stage IV25%23%21%22%21%22%19%20%21%29%25%0.501SWEDENNSQ (n = 16,847)Stage I87%91%87%92%90%92%93%94%93%94%95%<0.0001Stage II77%71%77%69%64%78%72%76%88%82%83%0.002Stage IIIA63%65%68%70%60%65%65%66%72%77%71%0.019Stage IIIB41%39%42%42%40%47%50%58%51%48%56%<0.0001Stage IV21%24%25%25%27%30%29%32%29%31%34%<0.0001SQ (n = 6574)Stage I77%88%82%74%81%83%85%85%86%87%89%0.024Stage II53%61%56%83%67%69%69%71%66%60%73%0.305Stage IIIA51%55%47%52%58%51%51%55%49%59%59%0.216Stage IIIB40%39%38%37%39%46%46%34%46%47%40%0.224Stage IV19%19%19%22%18%19%24%23%21%20%25%0.088* Includes only patients with valid TNM staging classification at diagnosis. TNM, tumour, nodes, and metastasis. Open table in a new tab Conclusions: Despite some improvements between 2005 and 2015, mainly in the short-term survival of pts with early-stage NSCLC, long-term OS rates for pts with late-stage disease did not change significantly and remained low. Even in pts with early-stage disease, OS outcomes were suboptimal, with a particular unmet need in the SQ population. Future analyses including data after 2015 will evaluate the potential impact on OS of increased use of new TKIs and immune checkpoint inhibitors. Editorial acknowledgement: Professional medical writing assistance was provided by Richard Daniel, PhD, of Parexel funded by Bristol-Myers Squibb. Legal entity responsible for the study: Bristol-Myers Squibb. Funding: Bristol-Myers Squibb. Disclosure: S. Ekman: Grants: BMS, during the conduct of the study. P. Horvat: Employee: IQVIA. D. Patel: Personal fees: BMS, during the conduct of the study. M. Roselund, A. Mette-Kejs: Fees for service to institution (IQVIA) during the conduct of this study: BMS; Employee: IQVIA. A. Juarez-Garcia: Employee: BMS. L. Lacoin: Consultant epidemiologist contracted by Bristol-Myers-Squibb for the SCAN-LEAF Project. All other authors have declared no conflicts of interest.