OBJECTIVES: This study aimed at quantifying the relationship of histological types of lung cancer and smoking behavior as well as common biomarkers in Chinese patients using real world data.

METHODS: Based on National Cancer Big Data Platform of China, all first-hospitalized medical records of lung cancer patients during 2011-2018 in the 13 chosen regional central cancer hospitals were retrospectively retrieved. Collected data included demographic, clinical, and histological, and smoking behavioral information of each patient. Available test results of biomarkers of the retrieved patients were collected and categorized as well.

RESULTS: We retrieved 38713 patients, of which 26152 (67.6%) were men and 12561 (32.4%) were women. The proportion of smoking was 77.1% in men and 13.7% in women. Among all patients with available staging data, 1160 (7.9%), 1081 (7.4%), 4084 (27.8%) and 8372 (57.0%) were in stage I, II, III and IV, respectively. As for all non-missing histological records, 4330 (23.7%) were small cell lung cancer (SCLC), and 13965 (76.3%) were non-small cell lung cancer. Adenocarcinoma patients (7840) was 1.45 times as much as squamous cell carcinoma (SCC) patients (5402). Among all smoking patients, 2934 (30.3%) had adenocarcinoma and 3906 (40.4%) had SCC, while in non-smoking patients, the numbers were 3962 (61.0%) and 915 (14.1%), respectively. Available test records of biomarker were found for 4791 patients. SCC patients had higher positive rates of cytokeratin 5/6 (92.2%), p40 (93.9%), and p63 (94.2%). As for adenocarcinoma patients, positive rates of cytokeratin 7 (96.7%), thyroid transcription factor-1 (TFF-1) (83.3%) were higher, while SCLC was associated with chromogranin A (66.4%), synaptophysin (84.5%), and TFF-1 (86.4%).

CONCLUSIONS: This study provides quantitative real-world evidence on the association of histological types with smoking and biomarkers. Tobacco control should be strengthened especially in men. Popularizing affordable and reliable biomarker tests may help to achieve more precise histological diagnosis.