Chest
Volume 67, Issue 4, April 1975, Pages 382-387
Journal home page for Chest

Clinical Investigations
Histologic Type of Lung Cancer in Relation to Smoking Habits, Year of Diagnosis and Sites of Metastases

https://doi.org/10.1378/chest.67.4.382Get rights and content

A study was made of histologic type of lung cancer in relation to smoking habit, year of diagnosis, age and sites of metastasis. It comprised 662 autopsies of men during the period from 1955 to 1972. As classified by the WHO system, 35.2 percent were epidermoid carcinoma, 24.6 percent were small cell carcinoma, 25.2 percent were adenocarcinoma and 14.2 percent were large cell undifferentiated carcinoma. The six non-smokers of the series were all found to be in class 3, adenocarcinoma. No clearcut and consistent relationships were observed. Although there was a steady decrease in the incidence of small cell carcinoma during this time period, this observation did not prove to be statistically significant. Small cell carcinomas increased with amount of smoking but not for all age groups. Adenocarcinomas decreased with advancing age but not in all smoking groups. Metastases were found in 96.3 percent of the cases and the sites most frequently involved were regional lymph nodes, liver, brain, distant lymph nodes, adrenals and bone. Small cell carcinomas showed the greatest percentage of involvement for those major sites and for the same sites, epidermoid carcinoma showed the lowest percentage.

Section snippets

MATERIALS AND METHODS

During the period from 1955 to 1972 at the Veterans Administration Hospital, East Orange, New Jersey, we collected autopsy specimens and smoking and residence histories for a series of studies relating smoking habits to histologic changes. The smoking histories were obtained by trained interviewers from the relatives of the deceased. Of the autopsies performed during this period of time, primary lung cancer was found to be the underlying cause of death in 1,093 cases. For this study, there were

Consistency of Readings

Table 2 shows the final classification by detailed histologic type of each of the 662 cases crosstabulated by the classification at the other reading. It also shows the number and percentage of discrepancies between the two readings which fall within the same major classification and the number and percentage of discrepancies between two readings which involved two separate classifications within the five major classifications.

Of the eleven subclassifications shown in Table 1, completely

DISCUSSION

As there has been a decline, over the past 15 years, in the amount of tars and nicotine in the cigarettes smoked in the United States, the effective dosage would be less in the later years of the study, even for persons who smoked the same number of cigarettes per day. For this reason, it is possible that the faster growing lung cancers might occur less frequently among patients who died of lung cancer between 1968-1972, the later time period covered by this study than in the earlier time

REFERENCES (12)

  • R Yesner et al.

    Application of the World Health Organization classification of lung carcinoma to biopsy material

    Ann Thorac Surg

    (1965)
  • L Kreyberg

    Histological lung cancer types

    (1962)
  • L Kreyberg

    Histological typing of lung tumors

    (1967)
  • G Saccomanno et al.

    Histologic types of lung cancer among uranium miners

    Cancer

    (1971)
  • W Weiss et al.

    Risk of lung cancer according to histologic type and cigarette dosage

    JAMA

    (1972)
  • R Yesner et al.

    A reappraisal of histopathology in lung cancer and correlation of cell types with antecedent cigarette smoking

    Am Rev Resp Dis

    (1973)
There are more references available in the full text version of this article.

Cited by (116)

  • Neuroendocrine neoplasms of the lung

    2022, Practical Pulmonary Pathology: A Diagnostic Approach
  • Metastases From Lung Cancer

    2021, Encyclopedia of Respiratory Medicine, Second Edition
  • Neuroendocrine Neoplasms of the Lung

    2018, Practical Pulmonary Pathology: A Diagnostic Approach A Volume in the Pattern Recognition Series
  • The effect of time changes in diagnosing lung cancer type on its recorded distribution, with particular reference to adenocarcinoma

    2016, Regulatory Toxicology and Pharmacology
    Citation Excerpt :

    In another study (Weiss et al., 1970), of 161 specimens of lung cancer, unanimity between pathologists was 47% for AdC, 43% for SqCC and 25% for SmCC. Despite increasingly well-defined systems of classification and guidelines emerging to assist pathologists, and their constant revision, discrepancies in classification have persisted (Auerbach et al., 1975; Cane et al., 2015; Roggli et al., 1985). Part of the problem resides in the notorious morphological heterogeneity of lung carcinoma rendering interpretation of multiple large sections from resected tumours (Roggli et al., 1985) or tumours sampled post mortem (Auerbach et al., 1975) particularly challenging.

  • Time trends in never smokers in the relative frequency of the different histological types of lung cancer, in particular adenocarcinoma

    2016, Regulatory Toxicology and Pharmacology
    Citation Excerpt :

    Thus, some studies (Campobasso et al., 1993; Greenberg et al., 1984; Vincent et al., 1977; Yesner et al., 1973) found a significant increase in the numbers of AdC when the diagnoses of histological type originally made some years earlier were reviewed, though others (Butler et al., 1987, Brownson et al., 1995) did not. Also, a number of studies that used standard criteria to review cases collected over at least a 10 year period (mean 21 years) found no evident increase in the proportion of lung cancers classified as AdC (Auerbach et al., 1975; Beard et al., 1988; Butler et al., 1987; Caldwell and Berry, 1996; Chan and Maclennan, 1977; Kennedy, 1973; Tanaka et al., 1988), although a few showed some increase (Andrews, Jr. et al., 1985; Valaitis et al., 1981; Wahbah et al., 2007). A fundamental question that could shed light on the underlying factors influencing observed rates of these two lung cancer types is whether the temporal patterns of the relative proportions of AdC vs. SqCC of the lung are similar in never smokers compared with smokers.

View all citing articles on Scopus

Manuscript received June 27; accepted September 3.

View full text