Stage 1 Lung Cancer Life Expectancy

6 Factors That Can Influence Survival Times

As the earliest stage of disease, stage 1 lung cancer generally has the most promising outlook. Current statistics suggest that anywhere from 70% to 92% of people with stage 1 non-small cell lung cancer (NSCLC) can expect to live at least five years following their diagnosis. Many patients live for far longer given newer and more effective therapies.

There are variables that can increase or decrease life expectancy in any stage of lung cancer. Understanding what they are—and changing any that are modifiable—can increase your chances of remission and help ensure your longest, healthiest life.

Characteristics of Stage 1 Lung Cancers

Lung cancer staging is a system that doctors use to determine the severity of the disease, the appropriate course of treatment, and the likely outcome (also known as the prognosis).

Non-small cell lung cancer, the most common form of the disease, is staged on a scale of 1 to 4, with stage 1 being the least serious and stage 4 being the most serious.

The cancer stage is determined using the TNM classification system which takes into account the size and extent of the main tumor (T), the number of nearby lymph nodes that have cancer (N), and whether the cancer has spread, or metastasized, to distant organs (M).

Stage 1 NSCLC is further broken down into two distinct stages:

  • Stage 1a lung cancers are constrained to the lungs and are 3 centimeters (cm), roughly 1½ inch, or less in diameter.
  • Stage 1b lung cancers are between 3 and 5 cm in diameter and have either spread to the main airways of a lung (the bronchus), spread to the innermost lining of the lung (the visceral pleura), or caused the collapse of a lung (atelectasis) or pneumonitis.

Stage 1a can be further broken down into three subtypes—stage 1a1, stage 1a2, and stage 1a3—based on their size, location, or cancer type. Each of these stages and sub-stages corresponds to a different five-year survival rate.

Stage 1 lung cancer is diagnosed when there is no evidence of cancer in nearby lymph nodes and no signs of metastasis.

Stage 1 Survival Statistics

Lung cancer survival is classified in different ways. Some estimate survival times based on the stage of the disease, while others do so based on the extent of the disease. Both methods have their advantages and drawbacks.

Survival Rates by TNM Stage

Some epidemiologists and countries (like the United Kingdom) categorize survival by the TNM stage. Based on revisions to the TNM classification system in 2018, the current five-year survival rate for stage 1 NSCLC is as follows:

Lung Cancer Stage 5-Year Survival Rate
1a1 92%
1a2 83%
1a3 77%
1b 86%

While the TNM approach can provide a generalized overview of survival rates in people with NSCLC, there are limitations to what it can predict. Certain fundamental factors—such as the location of the tumor and the degree of airway obstruction—can significantly reduce survival times and are not reflected in estimates.

Survival Rates by Disease Extent

Instead of classifying the disease by stage, scientists with the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program took a simpler approach, estimating survival based on the extent of the disease in the body.

Under the SEER classification system, lung cancer is classified in one of three ways:

  • Localized: Cancer confined to the lungs
  • Regional: Cancer that has spread to nearby lymph nodes or structures
  • Distant: Cancer that has spread to distant organs (metastatic disease)

Stage 1 lung cancer falls under the localized classification. According to SEER data from 2010 to 2016, stage 1 NSCLC has a five-year survival rate of 59%.

The downside to the SEER classification system is that allows for a significant overlap in definitions. For example, stage 1 NSCLC falls into the same "localized" category as stage 2a NSCLC given that neither involves lymph nodes. Even so, the five-year survival rate for stage 2a lung cancer in only 60% compared to 96% for stage 1a lung cancer.

Factors Influencing Survival Rates

Irrespective of whether TNM staging or SEER data is used, there are variables that can increase or decrease life expectancy in people with NSCLC. Some are non-modifiable, meaning that you cannot change them, while others are modifiable, meaning that you can.

Among the many factors that can influence survival rates, there are six that can add or subtract years in people with NSCLC.

These factors influence all stages of NSCLC—not just stage 1—although the outcomes are likely to be better with stage 1 disease given that it is the earliest, most treatable stage.

Age

Lung cancer typically affects people over 65. As a person ages, their general health tends to diminish, reducing their ability to fight the disease. This can directly influence survival times according to data from the SEER Program.

When lung cancer is stage 1(localized), five-year survival rates by age group are as follows:

  • Under 50: 83.7%
  • Ages 50-64: 67.4%
  • 65 and older: 54.6%

Performance Status

Performance status (PS) is a term used to describe how well or poorly a person is able to perform normal everyday tasks. PS is rated on either the Eastern Cooperative Oncology Group (ECOG) PS scale of 0 to 5 (with 0 being fully functional and 5 being death) or on the Karnosky PS scale of 0% to 100% (with 0% being death and 100% being fully functional).

Based on PS alone, researchers in Japan were not only able to predict five-year survival rates but median survival times as well. (Median survival time is the number of years that 50% of people with a disease live to or beyond.)

Using the ECOG classification system, lung cancer survival rates and times break down as follows:

Lung Cancer Survival by Performance Status
Performance Status 5-Year Survival Rates Median Overall Survival
0 45.9% 51.5 months
1 18.7% 15.4 months
2 5.8% 6.7 months
3 0% 3.9 months
4 0% 2.4 months
5 Not applicable Not applicable

Sex

A person's sex also factors into how long they will survive with lung cancer. Lung cancer tend to develop in women at a younger age than men. Even so, women with lung cancer tend to live longer than men, in part because they are diagnosed and treated earlier.

Data from Cancer Research UK confirms this, showing a larger percentage of women living at least five years following their diagnosis compared to men. Based on all stages of lung cancer, the current five- and 10-year survival rates for women and men break down as follows:

Lung Cancer Survival Rates by Sex
Sex 5-Year Survival Rate 10-Year Survival Rate
Women 19% 11.3%
Men 13.8% 7.6%
Overall 16.2% 9.5%

Smoking Status

Cigarette smoking is not only the number one cause of lung cancer in the United States but is also a factor that can influence survival times after the diagnosis is made 

Even if you quit smoking, having smoked in the past can cut your overall survival time by as much as 30%, especially if you are male.

Lung Cancer Survival by Smoking Status
Smoking Status 5-Year Survival Rate Median Overall Survival
Never smoker 34.9% 29.9 months
Never smoker (female) 36.7% 33.9 months
Never smoker (male) 29.9% 22.1 months
Ever smoker  26.3% 19.0 months
Ever smoker (female) 30.6% 22.0 months
Ever smoker (male) 25.8% 18.8 months

Current smoking poses an even greatest risk, cutting survival times by half compared to never smokers.

A comprehensive review of 10 lung cancer studies concluded that the five-year survival rate in current smokers with stage 1 NSCLC is 33%. By contrast, those who quit during or after treatment have a five-year survival rate of 70%.

Type of Lung Cancer

There are three main types of NSLC that vary by their incidence, aggressiveness, and parts of the lung they invade:

  • Lung adenocarcinoma, the most common type accounting to 40% of diagnoses that develops in the outer edges of the lung
  • Squamous cell lung carcinoma, the second most common type accounting for 25% to 30% of cases that mainly affects the airways of the lungs
  • Large cell lung carcinoma, a rare type of NSCLC that can develop in any part of the lung and tends to be very aggressive

Research published in Cancer Management Research concluded that survival rates varied by the cancer type, with lung adenocarcinoma being the most favorable overall.

5-Year Survival Rates by NSCLC Type
NSCLC Type 5-Year Survival Rate
Lung adenocarcinoma 20.6%
Squamous cell lung carcinoma 17.6%
Large cell lung carcinoma 13.2%

By contrast, people with SCLC have a five-year survival rate of just 5.6%.

Type of Surgery

Surgery is typically the treatment of choice for people with stage 1 NSCLC, and the type of surgery used can greatly influence survival times. The three most common forms of lung surgery are:

  • Wedge resection, also known as segmentectomy, in which a wedge of lung tissue containing a tumor is removed
  • Lobectomy, in which one of five lobes of the lung (two on the left, three on the right) are removed
  • Pneumonectomy, in which an entire lung is removed

Lobectomy is generally preferred for the treatment of stage 1 NSCLC. Even so, pneumonectomy cannot be avoided in certain cases, particularly in people over 70 in whom the surgery offers a higher chance of cure.

As a general rule, survival times tend to decrease in tandem with the amount of lung tissue removed. With pneumonectomy, the loss of life-years can be dramatic. According to a 2018 study in the Journal of Thoracic Diseases, people who undergo lobectomy have a five-year survival rate of 31.5% versus 15.6% who undergo pneumonectomy.

The risk of death is also greater, with the 90-day mortality rate for pneumonectomy hovering at 12.6% (or roughly one of every 12 surgeries). By contrast, the 90-day mortality for wedge resection and lobectomy are 5.7% and 3.9%, respectively.

According to a 2018 study in the Journal of Thoracic Disease, wedge resection surgery is associated with a five-year survival rate of 74% in people with stage 1 NSCLC.

A Word From Verywell

Although the prognosis for stage 1 lung cancer is generally better than other stages, this shouldn't suggest that there is "less" to worry about.

This is especially true when it comes to modifiable risk factors like smoking that can take back many of the gains you've made following lung cancer treatment. On the flip side, pulmonary rehabilitation can not help restore lung function but potentially extend survival times well.

By adjusting modifiable risk factors and embracing a healthier lifestyle, you not to stand to live longer but prevent the return of lung cancer.

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