Reporting net survival in populations: a sensitivity analysis in lung cancer demonstrates the differential implications of reporting relative survival and cause-specific survival

Figures & data

Table 1 Summary of clinical data^a and survival estimates among patients with non-small cell lung cancer

Stage/Age^b Stratum	Total, No.	Female, %	All-Cause Death, No.	Lung Cancer Death, No.	Relative Survival, %			Cause-Specific Survival, %
					Years Since Diagnosis			Years Since Diagnosis
					1	5	10	1	5	10
I/18–44	575	61	122	96	94.6	79.5	69.0	94.8	81.5	74.1
I/45–59	8266	54	2548	1838	91.0	67.9	56.7	92.4	73.1	65.5
I/60–74	25,942	50	10,813	7268	86.6	58.5	43.7	88.5	64.2	53.0
I/≥75	18,351	53	10,850	6943	79.8	47.8	34.3	80.2	49.8	37.3
Stage I total	53,134	52	24,333	16,145
II/18–44	198	50	86	76	86.6	55.3	46.3	88.2	58.1	49.8
II/45–59	2740	44	1448	1231	81.7	42.7	32.6	81.8	46.6	39.1
II/60–74	6410	42	3942	3187	74.9	34.2	22.8	76.0	38.1	29.3
II/≥75	3697	47	2819	2245	61.3	23.3	13.6	60.9	24.9	17.3
Stage II total	13,045	44	8285	6739
III/18–44	1264	47	900	844	64.3	22.2	16.1	62.8	23.8	18.6
III/45–59	14,337	41	10,600	9743	58.9	18.8	12.7	58.3	20.8	15.1
III/60–74	31,853	42	24,921	21,972	52.2	14.6	7.8	52.7	17.0	10.5
III/≥75	22,005	48	19,123	16,674	39.0	8.7	4.4	38.6	9.1	5.7
Stage III total	69,459	44	55,544	49,233
IV/18–44	3237	50	2704	2563	40.0	7.2	3.7	39.0	7.7	4.5
IV/45–59	31,198	43	27,485	26,223	32.0	4.3	2.1	30.5	4.7	2.4
IV/60–74	58,898	42	52,671	49,445	27.5	3.5	1.4	26.5	4.0	1.9
IV/≥75	34,923	48	32,294	29,868	21.3	2.7	0.9	20.1	2.7	1.0
Stage IV total	128,256	44	115,154	108,099

Notes: ^aClinical characteristics were extracted from the Surveillance, Epidemiology, and End Results data set. ^bAge, in years, at diagnosis.

Figure 1 Relative and cause-specific survival estimates by age group for patients with stage I (A), stage II (B), stage III (C), and stage IV (D) non-small cell lung cancer. The value in each box reports the percentage-point difference at 10 years since diagnosis (the 10-year cause-specific survival estimate minus the 10-year relative survival estimate).

Figure 2 Relative and cause-specific survival estimates by age group for patients who underwent surgery with stage I (A), stage II (B), stage III (C), and stage IV (D) non-small cell lung cancer. The value in each box reports the percentage-point difference at 10 years since diagnosis (the 10-year cause-specific survival estimate minus the 10-year relative survival estimate).

Table 2 Summary of clinical data^a and survival estimates among patients with non-small cell lung cancer who received surgery

Stage/Age^a Stratum	Total, No.	Female, %	All-Cause Death, No.	Lung Cancer Death, No.	Relative Survival, %			Cause-Specific Survival, %
					Years Since Diagnosis			Years Since Diagnosis
					1	5	10	1	5	10
I/18–44	520	62	83	62	98.2	85.6	74.3	97.7	87.3	79.1
I/45–59	6915	56	1679	1160	95.1	75.8	65.0	96.0	79.8	72.9
I/60–74	19,386	52	6405	4003	92.8	70.8	54.8	93.9	74.4	62.6
I/≥75	9941	53	4791	2608	89.6	67.9	51.5	89.8	66.7	52.3
Stage I total	36,762	53	12,958	7833
II/18–44	159	52	57	49	91.1	65.0	56.1	92.7	67.5	60.3
II/45–59	2078	46	975	818	87.5	50.0	38.8	87.6	53.6	45.3
II/60–74	4304	42	2271	1777	84.2	44.8	32.1	85.1	48.1	38.6
II/≥75	1811	46	1232	907	76.3	35.9	24.1	76.3	37.7	26.9
Stage II total	8352	44	4535	3551
III/18–44	320	53	158	147	87.9	48.9	37.0	84.9	50.0	37.9
III/45–59	3204	47	1732	1539	82.5	42.2	31.0	81.7	44.5	34.9
III/60–74	6070	45	3576	2995	78.1	37.2	24.3	78.3	39.4	28.6
III/≥75	2391	49	1677	1324	70.3	31.1	16.2	69.8	30.9	20.8
Stage III total	11,985	47	7143	6005
IV/18–44	220	59	157	145	61.0	21.9	15.4	60.9	24.0	19.5
IV/45–59	1557	51	1112	1047	62.2	21.8	12.0	61.3	23.3	13.9
IV/60–74	2613	48	1863	1682	60.8	21.2	10.9	60.3	22.1	13.1
IV/≥75	1138	49	894	782	51.4	18.3	11.3	49.7	17.8	10.6
Stage IV total	5528	49	4026	3656

Notes: ^aClinical characteristics were extracted from the Surveillance, Epidemiology, and End Results data set. ^bAge, in years, at diagnosis.

Figure S1 Crude mortality from cancer and noncancer causes by age group for patients with stage I (A), stage II (B), stage III (C), and stage IV (D) non-small cell lung cancer. Cumulative incidence of lung-cancer deaths (LC-CID) and cumulative incidence of nonlung-cancer deaths (non-LC-CID) were generated using a competing risk approach. Overall, LC-CID increased with advancing age and stage; similarly, non-LC-CID increased with advancing age and stage. Even though the total number of deaths increased with age, the proportion of deaths attributable to cancer in the older age group decreased because of increased competing causes of death.

Abbreviation: Cum. incidence, cumulative incidence.

Figure S2 Crude mortality due to cancer and noncancer causes by age group for patients with stage I (A), stage II (B), stage III (C), and stage IV (D) non-small cell lung cancer among patients who underwent surgery.

Abbreviation: Cum. incidence, cumulative incidence.

Data availability

This paper utilized publicly available data through the Surveillance, Epidemiology, and End Results (SEER) program.