Stage 3 Lung Cancer Survival Rate: Age, Cancer Type, and More

Stage 3 lung cancer is considered locally advanced with spread in the region near the site. Survival rates for stage 3 non-small cell lung cancer (NSCLC) range from as high as 36% to as low as 13%, depending on the subtype. There is also a five-year survival rate of 18% for small cell lung cancer (SCLC), a more rare but aggressive lung cancer type.

This advanced stage of the disease, in which the primary tumor has begun to invade nearby lymph nodes or structures, is sometimes (but not always) able to be treated with surgery. This plays a significant role in stage 3 lung cancer life expectancy. Your healthcare provider can help you to make informed choices about stage 3 treatment.

Characteristics of Stage 3 Lung Cancers

Lung cancer staging is primarily used to direct the appropriate course of treatment and predict likely outcome, or prognosis.

The staging of non-small cell lung cancer (NSCLC) involves the TNM classification system, used to assess the growth of the cancer and evaluate treatment options. The TNM system categorizes the disease based on:

• The tumor's size and extent (T)
• Whether lymph nodes are affected (N)
• Whether cancer has spread, or metastasized, to distant organs (M)

Stage 3 NSCLC is further divided into three substages:

• Stage 3a lung cancer is classified 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 be found in airway structures like the bronchus or trachea, heart structures like the pericardium or aorta, or the esophagus or breastbone.
• Stage 3b lung cancer is classified as advanced disease. It means that cancer has spread to the opposite side of the chest or to supraclavicular lymph nodes located above the collarbone.
• Stage 3c lung cancer is considered a progression of stage 3b, 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 area of the primary tumor.

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 lung cancer diagnosis. Many can live for far longer than this, depending on age, smoking status, and other factors.

The methods by which five-year survival rates are calculated can vary. Some estimates are based on the TNM stage and subtype classification.

There is also considerable overlap in the diagnostic criteria. Comparatively, stage 2b and stage 3a lung cancers have similar features and treatment approaches, as do stage 3b and stage 4a lung cancers.

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 three categories of disease progression rather than the stage:

• 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)

One of the drawbacks of the SEER classification system is, again, the overlap of definitions. Stage 3c lung cancer, for example, with a 13% five-year survival rate, falls into the same regional category as stage 2b, even though the latter has a much more optimistic five-year survival rate.

Factors Influencing Survival Rates

Certain factors are known to influence survival rates in people with stage 3 lung cancer, some of which are modifiable and others that are inherent and non-modifiable. They include:

• Age: Lung cancer survival rates are lower in older adults. In people with regional lung cancer, being 65 or older decreases five-year survival rates by 23% when compared to a matched set of adults under age 50. For small cell lung cancer (all stages), the five-year survival rate is cut in half when comparing people 65 or older to those under age 50.
• Smoking: The benefits of quitting cigarettes don't only extend to people with early-stage lung cancer but also to those with advanced stage 3 and stage 4 disease.
• Sex: Researchers report that females have a decreased risk of death due to NSCLC compared to a matched set of males with the same type of lung cancer. With stage 3 NSCLC specifically, females have a median survival rate of 12 months compared to nine months for males.
• Overall health: Co-occurring health conditions are common in people diagnosed with lung cancer, especially diabetes, chronic obstructive pulmonary disease, and congestive heart failure. These conditions have been linked to decreased overall survival in people with regional (stage 3b to stage 3c) disease.

Type of Lung Cancer

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

• Lung adenocarcinoma: The most common type, mainly affecting the outer edges of the lung
• Squamous cell lung carcinoma: The second most common type, which primarily occurs in the airways of the lung
• Large cell lung carcinoma: A rare and typically aggressive form that can develop in any part of the lung

These characteristics generally influence the treatment response rate and survival times in people with NSCLC. For small cell lung cancer, the five-year survival rate with regional spread is 19%.

Type of Surgery

With stage 3 NSCLC, lung cancer surgery is indicated only for stage 3a. Even so, there is a high risk of recurrence following stage 3 lung cancer surgery, which decreases 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). One study found that those treated with sleeve lobectomy had a 62.7% 5-year survival rate compared to 43.1% for those treated with pneumonectomy.

For people undergoing surgery for stage 3a NSCLC, a pre-operative course of chemotherapy (called neoadjuvant chemotherapy) or a post-operative course (called adjuvant chemotherapy) can improve survival times.

Immunotherapy treatments, like Keytruda (pembrolizumab) or Tecentriq (atezolizumab), are another option that may affect quality of life and survival times in specific cases.

Summary

The five-year survival rate for someone with non-small cell lung cancer varies on the basis of factors that include age, cancer subtype, cancer spread, and more. It also is measured in more than one way, and the data is based on the past. It doesn't always reflect newer advances in care right away.

Surgical treatment combined with pre-operative chemotherapy can improve survival times for some people. So can emerging treatment options, such as immunotherapies and targeted therapy. Talk with your cancer care team about the details of your diagnosis and the best treatment options.