Stage 3 Lung Cancer Life Expectancy

7 Factors That Can Influence Survival Times

Stage III non-small cell lung cancer is an advanced stage of the disease in which the primary tumor has begun to invade nearby lymph nodes or structures.

Learning that you have stage III lung cancer can be distressing, in part because some stage III tumors can be treated with surgery and others can't. There are also different five-year survival rates for stage III lung cancers, ranging from as high as 33% to as low as 13%.

Despite these statistics, there are many variables that can influence survival times. Some are non-modifiable, but others, like smoking, are modifiable and can increase life expectancy dramatically. By understanding the factors that influence lung cancer survival, you can make informed choices about your health and options for treatment.

Lung Cancer Staging

Lung cancer staging is primarily used to direct the appropriate course of treatment and predict the likely outcome (known as the prognosis). The staging of non-small cell lung cancer (NSCLC) involves the TNM classification system, which categorizes the disease based on tumor's size and extent (T), whether lymph nodes are affected (N), and whether cancer has spread, or metastasized, to distant organs (M).

Stage III NSCLC is further divided into three substages:

  • Stage IIIa lung cancer is described as locally advanced disease. This means that cancer has spread to lymph nodes on the same side of the lung as the primary tumor. Cancer may also be found in the bronchus, pleura, diaphragm, chest wall, breastbone, backbone, phrenic nerve, pericardium, vena cava, aorta, pharynx, trachea, esophagus, and carina (the area where the trachea attaches to the bronchus).
  • Stage IIIb lung cancer is considered advanced lung cancer. It means that cancer has spread to the opposite side of the chest or to supraclavicular lymph nodes located above the collarbone. Cancer may also be found in the same areas as stage IIIa lung cancer.
  • Stage IIIc lung cancer is considered a progression of stage IIIb with the addition of one or more tumors on the same or separate lobe of the lung. (There are three lobes on the right lung and two on the left.) Cancer may also be found in the same area as stage IIIa or IIIb disease.

The main difference between stage IIIa lung cancer and the other substages is that it can often be treated with surgery in much the same way as stage I and stage II lung cancer. Even so, the risk of recurrence is high after surgery.

By contrast, stage IIIb and IIIc disease are considered inoperable and are primarily treated with chemotherapy and radiation therapy.

Stage III Survival Statistics

Life expectancy in people with cancer is typically described in five-year survival rates, defined as the percentage of people who live for at least five years following their diagnosis. Many can live for far longer than this.

The methods by which five-year survival rates are calculated can vary. Some scientists base their estimates on the TNM stage, while others do so based on the extent of the disease in the body. Both methods have their benefits and drawbacks.

Survival Rates by TNM Stage

Many epidemiologists and health authorities estimate five-year survival rates based on the TNM stage. The current five-year estimates have been recently updated in line with the introduction of the revised stage IIIc classification in 2018.

5-Year Survival Rates by TNM Stage
Lung Cancer Stage 5-Year Survival Rate
IIIa 36%
IIIb 26%
IIIc 13%

While the TNM approach provides a generalized overview of survival times, there is a wide variation in how stage III lung cancer can progress. Some basic factors—like the location of the tumor and the degree of airway obstruction—can significantly impact survival times and are not reflected in a system like this.

Survival Rates by Disease Extent

To better address the wide variability of lung cancer in all of its stages, the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program took a simpler approach, basing survival rates on the progression of the disease rather than the stage.

Under the SEER system, survival rates are based on the extent of the disease in the body, irrespective of the type. Instead of multiple categories and subcategories, there are only three:

  • Localized: Cancer that is limited to lung tissue only
  • Regional: Cancer that has spread to nearby lymph nodes or structures
  • Distant: Cancer that has spread to distant organs (metastatic disease)
SEER 5-Year Survival Rates
Stage at Diagnosis Percent (%) Surviving
Localized 59%
Regional 31.7%
Distant 5.8%
Unstaged 8.3%

Under the SEER classification system, stage III NSCLC is regarded as regional disease with a five-year survival rate of 31.7%.

SEER 5-Year Survival Rates
Stage at Diagnosis Percent (%) Surviving
Localized 59%
Regional 31.7%
Distant 5.8%
Unstaged 8.3%

One of the drawbacks of the SEER classification system is the overlap of definitions. Stage III lung cancer, for example, falls into the same regional category as stage IIb lung cancer, even though the latter has a 53% five-year survival rate—significantly higher than either stage IIIa, IIIb, or IIIC disease.

Factors Influencing Survival Rates

Lung cancer is different from everyone. There is no one set course, and survival rates can only provide a rough estimate of the likely outcome. Multiple factors can influence survival rates, some of which are modifiable and other of which are inherent and non-modifiable.

There are seven factors that are known to influence survival rates in people with stage III lung cancer.

Age

Lung cancer survival rates tend to decrease the older you get. Although the average age of diagnosis is 70, a significant number of people are diagnosed in their 60s, 50s, and even younger.

Not only are people over 70 more likely to be in poorer health, but their immune system will generally be less responsive and less able to temper the growth of cancerous tumors.

In people with stage III lung cancer specifically, being 65 or older decreases five-year survival rates by nearly 40% compared to those under 50.

5-Year Survival Rate by Age Group
Stage at Diagnosis Under 50 Ages 50-64 65 and Over
Localized 83.7% 67.4% 54.6%
Regional 47.7% 36.6% 28.3%
Distant 11% 7% 4.7%
Unstaged 32.1% 15.4% 6%

Sex

Male sex is considered an independent indicator of poorer outcomes in people with lung cancer. According to a 2018 study in ESMO Open, women have a 27% decreased risk of death due to NSCLC compared to a matched set of men with the same type of lung cancer.

This is reflected in research from the United Kingdome in which women are nearly 40% more likely to survive for 10 years with lung cancer than men.

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%

Performance Status

Performance status (PS) is a term used to describe how well a person is able to function normally while living with cancer. It is measured in several different ways, the most common of which is the Eastern Cooperative Oncology Group (ECOG) method, which rates PS on a scale of 0 to 5 (0 being fully functional and 5 being dead).

People with higher PS almost invariably survive longer than those with lower PS. This is reflected in research published in the Journal of Thoracic Oncology in which increases in PS corresponds to increases in survival rates and survival times.

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

Smoking Status

Smoking affects every stage of lung cancer, from the onset of the disease to the overall survival times. By contrast, the benefits of quitting cigarettes don't only extend to people with early-stage lung cancer but also to those with advanced stage III and stage IV disease.

Studies have shown that smoking not only reduces the response rates to cancer therapy compared to quitting (45% vs. 75%, respectively) but also cuts two-year survival rates by 41%.

Moreover, in people with advanced lung cancer, smoking increases pain scores and while reducing a person's performance status. Both are associated with lower survival rates.

Lung Cancer Type

There are many different types and subtypes of NSCLC, some of which are more aggressive than others. The three most common are:

These characteristics can greatly influence the treatment response rate and, in turn, survival times in people with NSCLC.

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%

Presence of Comorbidity

Comorbidity is a term used to describe co-occurring illnesses. In people with lung cancer, the likelihood of a comorbid condition is high, most commonly diabetes, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF).

A 2015 study from the University of Nebraska involving 5,683 people with lung cancer reported that 73% had a comorbid illness. Of these, three comorbidities were linked to decrease overall survival in people with regional (stage IIb to stage IIIc) disease.

Regional NSCLC Comorbidity and Survival
Comorbid Condition Reduction in Overall Survival
Congestive heart failure Reduction of 26%
Kidney disease Reduction of 44%
Dementia Reduction of 233%

Type of Lung Cancer Surgery

Lung cancer surgery is indicated only for stage IIIa NSCLC. Even so, there is a high risk of recurrence following stage III lung cancer surgery, which alone decreases survival times.

According to 2014 research publishing in Oncology Letters, the median survival time for people with post-surgical recurrence (for all stages) is 21.9 months. For people with stage III disease, survival times are even shorter.

For people undergoing surgery for stage IIIA NSCLC, a pre-operative course of chemotherapy (called neoadjuvant chemotherapy) can improve survival times, in part by lowering the risk of lung cancer recurrence.

The choice of surgery can also influence survival times. The use of lobectomy (in which a lobe of a lung is removed) tends to afford longer survival times than a pneumonectomy (in which an entire lung is removed).

When used with neoadjuvant chemotherapy, lobectomy is associated with a 33% five-year survival rate in people with stage IIIa lung cancer. By contrast, pneumonectomy with neoadjuvant chemotherapy translates to a 20.7% five-year survival rate.

A Word From Verywell

A stage III lung cancer diagnosis can be daunting, but the fact this it is "advanced" does not mean that is untreated. Certain stage III lung cancers can be cured, and others can be effectively be managed with longer progression-free survival time than ever before.

When diagnosed with stage III lung cancer, try not to focus on survival rates. These statistics are based on people of different ages, some of whom are in good health and others of whom are not. Instead, focus on factors that can improve your chances of survival, including smoking cessation, proper nutrition, and exercise. The stronger and more fit you are, the more likely you to tolerate treatment and maintain (or improve) your performance status.

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