The relationship between risk factors

and histology in lung cancer

Turkish Thoracic Society Lung and Pleural Malignancies Study Group

The map of lung cancer in Turkey

9 provinces, 25 centers, 105 investigators

Method

• Analysis of data of “The project of the map of lung cancer in Turkey”

• The aim of the study was to investigate the relationship between risk factors and histology in lung cancer

• The project of the map of lung cancer in Turkey– The patient diagnosed as primary lung cancer between

01.01.2005 and 31.12.2005– 9 provinces, 25 centers, 105 investigators

• The provinces of incidence: İzmir, Bursa, Trabzon, Erzurum, Sivas, Diyarbakır, Antalya

• Ankara, İstanbul

İzmir M: 57.3F: 6.2

Age-standardised incidence rates

SivasM: 38.7F: 6.6

TrabzonM: 48.9F: 4.1

ErzurumM: 36.5F: 5.2

DiyarbakırM: 13.7F: 2.1

AntalyaM: 25.8F: 3.4

BursaM: 35.5F: 3.5

Total: M: 41.7 F: 4.8 n/100.000

Histological types

N %Squamous 2145 29.4

Adeno 1263 17.3

(BAC) 40 0.6

Large cell 116 1.6

Adenosquamous 24 0.3

NSCLC, unspecified 1681 23.0

Small cell 1129 15.5

Sarcomatoid carcinoma

24 0.3

Carcinoid 35 0.5

Salivary gland-type 5 0.07

Other 874 12.0

NSCLC

5259

71.9%

Risk factors

Cigarette smoking 91.5%

Environmental asbestos exposure

11.6%

Lung cancer in family 9.6%

Fibrotic scar due to TB 7.0%

Tumor close to the scar 2.8%

COPD 21.6%

Connective tissue diseases 0.2%

IPF 0.3%

Yaşa spesifik insidans hızı, erkek

0

50

100

150

200

250

300

350

0-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85 +

Age-specific incidence rate

Male

n/100.000

Age-specific incidence rate

Yaşa spesifik insidans hızı, kadın

05

101520253035404550

0-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85 +

Femalen/100.000

Sex & Age

•Total 7303 cases

•Sex Male: 90.5% Female: 9.5%

• Age

•All group: Mean: 60.7 + 10.7 (21 -105)

•Male

•Mean: 60.7 + 10.5

•Peak value of incidence: 70-74 300/100.000

•Kadın

•Mean : 60.9 + 12.5

•Peak value of incidence: 80-84 45/100.000

Age groups & Histological types

P<0.01

Large Small Squamous Adeno TotalLarge Small Squamous Adeno Total

Total

14 73 93 110 290

4,8% 25,2% 32,1% 37,9% 100,0%

101 1033 2003 1132 4269

2,4% 24,2% 46,9% 26,5% 100,0%

115 1106 2096 1242 4559

2,5% 24,3% 46,0% 27,2% 100,0%

% sira icinde

% sira icinde

% sira icinde

44 ve alti

45 ve uzeri

Toplam

Buyuk h Kucuk h Skuamoz Adeno

Histolojik Gruplar

Toplam

P<0.01

Age groups & Histological types

Large Small Squamous Adeno Total

45 age ↑

45 age ↓

Total

Large cell Small cell Squamous Adeno Total

Male 104

2.5%

1030

24.4%

2065

48.9%

1020

24.2%

4219

100%

Female 12

2.8%

99

22.8%

80

18.4%

243

56.0%

434

100%

Sex & Histological types

9 165 307 218 699

1,3% 23,6% 43,9% 31,2% 100,0%

17 66 118 69 270

6,3% 24,4% 43,7% 25,6% 100,0%

19 232 373 213 837

2,3% 27,7% 44,6% 25,4% 100,0%

2 14 15 7 38

5,3% 36,8% 39,5% 18,4% 100,0%

3 38 73 17 131

2,3% 29,0% 55,7% 13,0% 100,0%

19 235 606 243 1103

1,7% 21,3% 54,9% 22,0% 100,0%

34 320 500 414 1268

2,7% 25,2% 39,4% 32,6% 100,0%

2 11 44 11 68

2,9% 16,2% 64,7% 16,2% 100,0%

11 48 109 71 239

4,6% 20,1% 45,6% 29,7% 100,0%

116 1129 2145 1263 4653

2,5% 24,3% 46,1% 27,1% 100,0%

Ankara

Antalya

Bursa

Diyarbakir

Erzurum

Istanbul

Izmir

Sivas

Trabzon

Toplam

Büyükhücreli

Küçükhücreli Skuamoz Adeno ca Toplam

Provinces & Histological types

Large Small Squamous Adeno Total

Total

Large cell Small cell Squamous Adeno Total

Non-smoker

9

3.1%

43

14.6%

46

15.6%

197

66.8%

295

100%

Smoker 84

2.4%

847

24.3%

1726 49.6%

822

23.6%

3479

100%

Smoking & Histological types

Large cell Small cell Squamous Adeno

Non-smoker

9

9.7%

43

4.8%

46

2.6%197

19.3%

Smoker 84

90.3%

847

95.2%

1726 97.4%

822

80.7%

Total 93

100%

890

100%

1772

100%

1019

100%

Smoking & Histological typesN Packet year (Mean)

Large cell 21 40.9

Small cell 160 53.1

Squamous 465 52.2

Adeno 219 42.5

Total 865 49.6

Comparison according to packet year

Large cell Small cell Squamous Adeno Total

Non-smoker

8

3.4%

34

14.7%

40

17.2%

150

64.7%

232

100%

Passive smoker

1

1.6%

9

14.3%

6

9.5%

47

74.6%

63

100%

Passive smoking & Histological types

P=0.00

Smoking & Histological types filter & no filter

Filter

No-filter

P=0.00

No

Yes

Smoking & Histological types Roller tobacco

Total

%Sivas 43.6

Diyarbakır 28.3

Ankara 24.1

İzmir 11.9

İstanbul 11.4

Antalya 11.1

Trabzon 3.5

Bursa 0.7

Erzurum 0.0

Environmental asbestos exposure

Exposure Large cell Small cell Squamous Adeno Total

No 72

2.4%

729

23.9%

1432

47.0%

814

26.7%

3047

100%

Yes 16

2.9%

125

23.0%

260

47.9%

142

26.2%

543

100%

Environmental asbestos exposure &

Histological types

COPD Large cell Small cell Squamous Adeno Total

No 67

2.4%

663

24.7%

1217

44.2%

797

29.1%

2739

100%

Yes 22

2.4%

204

22.0%

507

54.7%

194

20.9%

927

100%

COPD & Histological types

Fibrotic scar

Large cell Small cell Squamous Adeno Total

No 74

2.4%

751

24.2%

1436

46.3%

838

27.0%

3099

100%

Yes 8

2.5%

51

15.9%

181

56.6%

80

25.0%

320

100%

Fibrotic scar due to TB & Histological types

Tumor close to the scar

4

3.3%

16

13.1%

68

55.7%

34

27.9%

320

100%

Heating systems & Histological types

Heating Large cell Small cell Squamous Adeno Total

Stove/ fireplace

65

2.4%

639

23.4%

1341

49.0%

689

25.2%

2734

100%

Other 14

2.4%

151

25.5%

236

39.9%

191

32.3%

592

100%

P=0.113

Previous cancer & Histological types

Previous cancer No

Yes

Total

Large Small Squamous Adeno Total

P=0.018

Lung cancer in family & Histological types

L.cancer in family No

Yes

Un-known

Total

Large Small Squamous Adeno Total

RESULTS-1

• Squamous cell is the most frequent type

• Adenocancer is the most frequent type below– Younger patients– Females– Non.smokers– Passive smokers

• Adenocancer– 80% of them are smokers; there is a relationship with smoking– By changing smoking style, adenocancer increasing

• More developed cities and young people – Adenocancer may be first type in next 20 years in Turkey

RESULTS-2

• There is no influence asbestos exposure on histological type

• Adenocancer is not the most common type among patients with fibrotic scar due to TB

• Indoor smoke increases risk of squamous type; while decreasing indoor smoke risk, adenocancer increasing

• Cancer history increases risk of adenocancer– Genetic susceptibility & adenocancer?