Skip to content

Lung adenocarcinoma — statistics and effect-size ledger

Purpose and interpretation rules

This sheet preserves reusable denominators, effect sizes, confidence intervals, dates, populations, and methods. It is not a treatment algorithm. Unless a row explicitly says adenocarcinoma, the estimate applies to broader lung cancer or NSCLC and must not be silently relabelled.

  • HR/RR below 1 favors the first-listed intervention for the adverse endpoint stated.
  • Medians cannot be subtracted to estimate an individual's survival gain.
  • Single-arm response rates do not rank therapies across trials.
  • DFS, EFS, PFS, OS, pCR, ORR, and patient-reported outcomes are not interchangeable.
  • Modelled burden, registry incidence, and trial efficacy answer different questions.
  • Every PMID below was resolved through live PubMed E-utilities on 2026-08-29.
Domain Population/method Estimate Boundary Source
Global lung-cancer burden, 2022 GLOBOCAN model, 185 countries Lung cancer was the most commonly diagnosed cancer and leading cancer-death cause Not histology-specific PMID 38572751
Adenocarcinoma distribution, 2022 GLOBOCAN/CI5/AFCRN reconstruction Leading lung-cancer subtype in most assessed countries Modelled subtype estimates PMID 39914442
Japan localized adenocarcinoma trend 62,870 cases, 1993–2015 Annual change +4.5% men; +5.7% women Detection/classification contribute PMID 35138642
Metastatic lung-cancer 1-y survival California registry, 186,156 cases, 1990–2014 18.4% → 29.4% All histologies PMID 33414054
US NSCLC mortality SEER incidence-linked mortality, men, 2013–2016 Mortality −6.3%/y; incidence −3.1%/y Temporal attribution, not randomized PMID 32786189
US 2-y lung-cancer-specific survival Diagnoses 2001 vs 2014 26% → 35% All NSCLC mix PMID 32786189
Deaths averted 1975–2020 US national modelling Tobacco control dominant; screening/treatment add later gains Model-dependent decomposition PMID 39636625

Tobacco, never-smoking, pollution, and susceptibility

Exposure/population Estimate Method/caution Source
Biochemically confirmed active smoking in women RR 7.8 vs non-smokers Prospective cohort; historical exposure PMID 7669596
Spousal second-hand smoke RR 1.24 (95% CI 1.13–1.36) 37-study meta-analysis; 4,626 never-smoker cases PMID 9365295
Spousal second-hand smoke, later synthesis RR 1.25 (1.15–1.37) 51 studies, 7,369 cases PMID 12058801
Workplace second-hand smoke RR 1.17 (1.04–1.32) Observational synthesis PMID 12058801
Japanese never-smoking women 109 lung cancers/28,414 over 13 y; 82 adenocarcinomas Prospective cohort; exposure-dependent spousal association PMID 17935128
COPD SRR 2.06 (1.50–2.85) Prospective-cohort meta-analysis; shared smoking confounding PMID 29100446
Emphysema SRR 2.33 (1.56–3.49) Same synthesis PMID 29100446
Asian advanced adenocarcinoma EGFR prevalence 51.4% of 1,450 evaluable tumors PIONEER; advanced Asian cohort, not global PMID 24419411
Never-smoker geographic KRAS variation 3.8× more frequent in North America/Europe than East Asia 871 tumors, 28 locations; research cohort PMID 40604281
Air-pollution mechanistic cohort set 32,957 EGFR-driven cases across four within-country cohorts PM2.5 association plus mouse/organoid IL-1β experiments PMID 37020004
Never-smoker TALENT screening High early-stage detection in risk-enriched cohort Single arm; no mortality or overdiagnosis comparator PMID 38042167

Screening efficacy and harms

Study/policy Population Benefit Harm/implementation Source
NLST 53,454 high-risk participants Lung-cancer mortality −20.0% (95% CI 6.8–26.7); all-cause −6.7% Trial positivity generated many false positives PMID 21714641
NLST initial round LDCT arm Positive screen 27.3%; cancer in 3.8% of positive screens Older low positivity threshold PMID 23697514
NELSON men 13,195 men 10-y lung-cancer mortality rate ratio 0.76 (0.61–0.94) Volumetry/doubling-time protocol PMID 31995683
NELSON women 2,594 women Smaller subgroup; favorable mortality direction Underpowered sex-specific estimate PMID 31995683
USPSTF 2021 eligibility US adults Annual LDCT age 50–80, ≥20 pack-years, current or quit ≤15 y Policy threshold, not biologic boundary PMID 33687470
Risk-model selection US modelling More cost-effective at selected thresholds than categorical rules Assumptions drive result PMID 36745885
Never-smoker screening TALENT ages 55–75 with added risks Substantial detection, enriched by family history No randomization; cannot infer mortality benefit PMID 38042167

Histology, grade, and staging

Domain Denominator/result Interpretation Source
TCGA adenocarcinoma 230 resected tumors Mean 8.9 somatic mutations/Mb; 18 significantly mutated genes Resection cohort, bulk multi-omics
AIS/MIA outcome Resected cohorts Near-100% disease-specific survival after complete resection Requires complete sampling/classification
STAS staging evaluation 4,061 pathologic stage-I NSCLCs Prognostic descriptor proposed, not T-category determinant Retrospective international analysis
TNM-9 source database 124,581 registrations 76,518 informed stage-group analysis International registry; exclusions apply
TNM-9 clinical-stage analysis 58,193 cases Used in stage-group proposal Histology mixed
TNM-9 pathologic-stage analysis 39,192 cases Used in stage-group proposal Operated selection
TNM-9 best-stage analysis 62,611 cases Used in stage-group proposal Mixed clinical/pathologic information
TNM-9 metastatic analysis 14,937 stage IVA–IVB NSCLCs Supported M1c single- versus multiple-organ subdivision Prognostic, not treatment selector

Surgery and local consolidation

Trial/setting Comparison Estimate Boundary Source
JCOG0802/WJOG4607L Segmentectomy vs lobectomy, peripheral ≤2 cm OS criterion favored segmentectomy; more local relapse Selected Japanese peripheral tumors PMID 35461558
CALGB 140503 Sublobar vs lobar, peripheral cT1aN0 ≤2 cm DFS noninferior; OS similar Intraoperative node-negative confirmation PMID 36780674
Gomez oligometastatic phase II Local consolidation vs maintenance/observation PFS 14.2 vs 4.4 mo; OS 41.2 vs 17.0 mo 49 selected patients; older systemic era PMID 31067138
Iyengar phase II SABR + maintenance vs maintenance PFS 9.7 vs 3.5 mo Small trial stopped early for efficacy PMID 28973074
SABR-COMET SABR vs standard care, mixed cancers Long-term OS benefit NSCLC subset small PMID 32484754

Adjuvant and perioperative therapy

Trial/analysis Comparison Effect size Key boundary Source
LACE Cisplatin chemotherapy vs none; 4,584 resected NSCLCs OS HR 0.89 (0.82–0.96); 5-y absolute benefit 5.4% Historical, mixed histology PMID 18506026
LACE stage IA Same OS HR 1.40 No demonstrated benefit PMID 18506026
LACE stage IB Same OS HR 0.93 Modest/uncertain PMID 18506026
LACE stage II Same OS HR 0.83 Benefit-concentrated subgroup PMID 18506026
LACE stage III Same OS HR 0.83 Benefit-concentrated subgroup PMID 18506026
ADAURA stage II–IIIA Osimertinib vs placebo DFS HR 0.17 EGFR exon19del/L858R; optional chemotherapy PMID 32955177
ADAURA stage IB–IIIA Osimertinib vs placebo DFS HR 0.20 Three-year planned therapy PMID 32955177
ADAURA OS Osimertinib vs placebo Death HR 0.49; 5-y OS 88% vs 78% Salvage patterns evolve PMID 37272535
CheckMate 816 Nivolumab-chemo vs chemo EFS 31.6 vs 20.8 mo; HR 0.63 (97.38% CI 0.43–0.91) Mixed NSCLC, driver caveats PMID 35403841
CheckMate 816 pCR Same 24.0% vs 2.2% pCR prognostic, not individual switch rule PMID 35403841
CheckMate 816 surgery Same Surgery 83.2% vs 75.4% Protocol-selected resectable population PMID 35403841
CheckMate 816 grade 3–4 AE Same 33.5% vs 36.9% Treatment-related PMID 35403841
KEYNOTE-671 Perioperative pembrolizumab vs placebo 24-mo EFS 62.4% vs 40.6%; HR 0.58 Cannot isolate adjuvant component PMID 37272513
KEYNOTE-671 pCR Same 18.1% vs 4.0% Mixed histology PMID 37272513
KEYNOTE-671 grade ≥3 AE Same 44.9% vs 37.3% Treatment-related PMID 37272513
AEGEAN Perioperative durvalumab vs placebo EFS HR 0.68 (0.53–0.88); pCR 17.2% vs 4.3% EGFR/ALK excluded from efficacy analysis PMID 37870974
AEGEAN grade 3–4 AE Same 42.4% vs 43.2% Treatment-related PMID 37870974
IMpower010 Atezolizumab vs supportive care after chemotherapy DFS HR 0.66 in stage II–IIIA PD-L1 ≥1% Hierarchical analysis PMID 34555333
KEYNOTE-091 Pembrolizumab vs placebo DFS HR 0.76 overall; PD-L1 ≥50% HR 0.82, not significant at interim PD-L1 pattern differs from metastatic setting PMID 36108662
PACIFIC five-year Durvalumab vs placebo after chemoradiation OS 42.9% vs 33.4%; PFS 33.1% vs 19.0% Unresectable stage III, mixed histology PMID 35108059

EGFR-targeted therapy

Trial Comparison/population Efficacy Safety/interpretation Source
IPASS mutation-positive Gefitinib vs carboplatin-paclitaxel PFS HR 0.48 Predictive interaction PMID 19692680
IPASS mutation-negative Same Gefitinib HR 2.85, favoring chemotherapy Clinical phenotype cannot replace genotype PMID 19692680
FLAURA Osimertinib vs gefitinib/erlotinib PFS 18.9 vs 10.2 mo; HR 0.46 Classical EGFR mutations PMID 29151359
FLAURA OS Same OS 38.6 vs 31.8 mo; HR 0.80 Crossover/subsequent therapy matter PMID 31751012
FLAURA2 Osimertinib + platinum-pemetrexed vs osimertinib PFS 25.5 vs 16.7 mo; HR 0.62 Added chemotherapy burden PMID 37937763
MARIPOSA Amivantamab-lazertinib vs osimertinib PFS 23.7 vs 16.6 mo; HR 0.70 Infusion, rash, edema, VTE PMID 38924756
AURA3 Osimertinib vs platinum-pemetrexed in T790M PFS 10.1 vs 4.4 mo; HR 0.30 Post-earlier-generation setting PMID 27959700
PAPILLON Amivantamab-chemo vs chemo, EGFR exon20ins PFS 11.4 vs 6.7 mo; HR 0.40 First-line exon-20 insertion PMID 37870976

Fusion-driver therapy

Driver/trial Population Estimate Boundary Source
ROS1 crizotinib Advanced ROS1-positive NSCLC ORR 72%; median PFS 19.2 mo Single-arm expansion PMID 25264305
RET selpercatinib RET-fusion NSCLC High response including CNS activity Single-arm foundational cohorts PMID 32846060
LIBRETTO-431 Selpercatinib vs platinum-pemetrexed ± pembrolizumab Median PFS 24.8 vs 11.2 mo Interim efficacy population PMID 37870973
NTRK larotrectinib TRK-fusion cancers High pooled response Tissue-agnostic; small lung subset PMID 29466156
ALINA Alectinib vs platinum chemotherapy after resection Large DFS/CNS benefit Mature OS and chemo additivity unresolved PMID 38598794

KRAS, BRAF, MET, and HER2 therapy

Trial Population Efficacy Major caution Source
CodeBreaK 100 Previously treated KRAS G12C NSCLC ORR 37.1%; median PFS 6.8 mo Single arm PMID 34096690
CodeBreaK 200 Sotorasib vs docetaxel PFS HR 0.66; 5.6 vs 4.5 mo No demonstrated OS advantage; crossover PMID 36764316
KRYSTAL-1 Adagrasib, previously treated G12C ORR 42.9%; median PFS 6.5 mo Single arm PMID 35658005
MET capmatinib METex14 cohorts Higher ORR untreated than pretreated Single-arm; edema PMID 32877583
MET tepotinib METex14 cohorts Clinically meaningful response Single-arm; assay and edema PMID 32469185
DESTINY-Lung01 T-DXd, HER2-mutant NSCLC ORR 55%; duration 9.3 mo; PFS 8.2 mo ILD 26%, including deaths PMID 34534430
DESTINY-Lung02 T-DXd 5.4 vs 6.4 mg/kg cohorts Activity preserved at lower dose Lower dose favored benefit-risk PMID 37694347

Driver-negative immunotherapy

Trial Comparison Estimate Boundary Source
KEYNOTE-024 Pembrolizumab vs chemo, TPS ≥50% PFS 10.3 vs 6.0 mo; HR 0.50; ORR 44.8% vs 27.8% EGFR/ALK-negative selected group PMID 27718847
KEYNOTE-189 Pembrolizumab-platinum-pemetrexed vs chemotherapy Initial OS HR 0.49; PFS HR 0.52 Metastatic nonsquamous, EGFR/ALK-negative PMID 29658856
IMpower150 Atezolizumab-bevacizumab-carboplatin-paclitaxel vs bevacizumab-chemo OS/PFS benefit Four-drug burden; mixed biomarkers PMID 29863955
PD-L1-negative pooled 5-y Pembrolizumab-chemo vs chemo OS HR 0.64 (0.51–0.79); PFS HR 0.66 (0.54–0.81); 5-y OS 12.5% vs 9.3% Squamous+nonsquamous pooled PMID 38642841
EGFR-mutant PD-L1-positive pilot Pembrolizumab, TKI-naive No objective responses among eligible EGFR-mutant patients Small phase II; stopped for futility PMID 29874546

ctDNA, MRD, and implementation

Setting Denominator/result Meaning Source
Localized lung-cancer MRD Post-treatment ctDNA anticipated radiographic recurrence in some patients Strong prognosis; action utility unproven PMID 28899864
TRACERx phylogenetic ctDNA Personalized subclonal tracking Reveals relapse evolution; low-shedding limitation PMID 28445469
LUNGCA-1 Prospective multicentre postoperative cohort ctDNA positivity associated with recurrence Not randomized intervention
Newly diagnosed metastatic plasma NGS Prospective complementary testing Added actionable detections to tissue Negative plasma non-exclusionary
Reflex testing Program implementation Increased completion and reduced ordering loss Center-specific workflow

Patient experience, palliative care, and safety

Domain Population/result Estimate Source
Early palliative care 151 metastatic NSCLC patients 12-wk FACT-L 98.0 vs 91.5; depression 16% vs 38%; aggressive end-of-life care 33% vs 54%; OS 11.6 vs 8.9 mo PMID 20818875
T-DXd ILD DESTINY-Lung01 Adjudicated drug-related ILD 26%, including fatal events PMID 34534430
CheckMate 816 severe AE Neoadjuvant nivolumab-chemo vs chemo Grade 3–4 treatment-related AE 33.5% vs 36.9% PMID 35403841
KEYNOTE-671 severe AE Perioperative pembrolizumab vs placebo Grade ≥3 treatment-related AE 44.9% vs 37.3% PMID 37272513
AEGEAN severe AE Perioperative durvalumab vs placebo Grade 3–4 treatment-related AE 42.4% vs 43.2% PMID 37870974

Known conflicts and caveats

Conflict Why estimates differ Rule for reuse
Adenocarcinoma burden Registry histology coverage, imputation, diagnostic era Keep model, year, sex, and geography
Never-smoker fraction Definition, geography, sex, referral enrichment Do not quote a universal percentage without denominator
Screening harms Positivity threshold, volumetry, round, work-up algorithm Keep trial/program and definition
Driver frequency Ancestry, smoking, stage, assay, tissue adequacy Never use phenotype to skip testing
PFS across targeted trials Line, comparator, CNS eligibility, follow-up No cross-trial ranking
PD-L1 Assay, cutoff, biopsy site, treatment exposure Record clone, score, specimen, date
MRD sensitivity Tumor burden, shedding, assay and sampling time Negative is not proof of cure
Perioperative EFS Stage editions and therapy architecture differ Do not infer adjuvant-component value
OS Crossover and subsequent therapies vary Report treatment switching and follow-up

Reuse checklist

  1. Preserve population, histology, stage, genotype, and line.
  2. Preserve comparator, endpoint, time point, and confidence interval.
  3. Label randomized, single-arm, observational, or modelled evidence.
  4. Do not average conflicting estimates.
  5. Re-query living guidelines and trial status at use.
  6. Reproduce derived values only with the original numerator and denominator.

Linked evidence layers