European Journal of Cardiovascular Medicine

Bronchogenic carcinoma, a leading cause of cancer morbidity and mortality globally, presents a significant public health challenge, particularly in regions with high smoking prevalence such as South India. The disease primarily manifests in the form of non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC), with varying results concerning demographics, clinical characteristics, and treatment outcomes (Bhandary et al., 2019; , Medika, 2023). The burden of lung cancer in South India is particularly noteworthy, as the region's unique socio-economic parameters, tobacco usage patterns, and access to healthcare contribute to variations in epidemiological trends. Recent literature indicates that smoking remains the predominant risk factor for bronchogenic carcinoma, implicated in over 85% of cases (Marie et al., 2023; Bhaskar et al., 2018).

Age and sex are critical factors in the distribution of bronchogenic carcinoma. Studies have consistently demonstrated peak incidence rates in older adults, particularly those in their sixth and seventh decades of life (Bhandary et al., 2019; Kulothungan et al., 2022). Gender disparities also exist, with males traditionally exhibiting higher incidence rates than females, although the gap is narrowing in many countries due to changing smoking patterns among women (Garg et al., 2019). Compounding these factors is the influence of comorbidities such as chronic obstructive pulmonary disease (COPD) and tuberculosis, which are prevalent in the Indian population and can complicate the clinical management of bronchogenic carcinoma (Abdelwahab et al., 2020).

Given the aggressive nature of bronchogenic carcinoma, early diagnosis and prompt treatment are critical. Diagnostic modalities play a pivotal role, with advances in imaging techniques such as computed tomography (CT), positron emission tomography (PET), and bronchoscopy improving disease detection rates. Histological evaluation reveals a predominance of adenocarcinomas and squamous cell carcinomas, consistent with findings from various studies across the Indian subcontinent (Fawzy et al., 2021; Ravikanth & Reddy, 2022). Staging of the disease is crucial in dictating treatment strategies, with advanced stages correlating with poorer prognosis and shorter survival durations (Rashid et al., 2023).

As such, this clinico-epidemiological study aims to delineate the demographic, clinical, and pathological characteristics of bronchogenic carcinoma within a tertiary care setting in South India, exploring additional factors such as smoking history, symptomatology, diagnostic yield, and treatment received. The findings of this investigation will contribute to a better understanding of bronchogenic carcinoma in this region, emphasizing the need for targeted interventions to reduce the burden of lung cancer, enhance early detection, and improve patient outcomes.

A total of 160 patients formed the study sample. All patients with tissue diagnosis of bronchogenic carcinoma from the Pulmonary medicine department of the tertiary care centre were included. Patients with other malignancies, and malignant pleural effusion with no definite evidence of bronchogenic carcinoma ware excluded. The variables included age, sex, smoking index, age at smoking initiation, and duration of smoking, which were evaluated to understand their association with bronchogenic carcinoma. Clinical characteristics such as presenting symptoms, physical findings, and comorbidities were also systematically described to capture the typical patient presentation in this setting.

The diagnostic modalities used and their respective yields were explored to assess the effectiveness of various investigative techniques. Furthermore, the histopathological types and clinical staging of lung cancer were examined to delineate the spectrum of disease severity at the time of diagnosis. Treatment patterns were categorized, and the presence and sites of metastasis were documented. Measurement of patients’ level of physical activity (performance status) was done by WHO performance status scale). Finally, survival duration post-diagnosis was analysed to provide preliminary insight into patient outcomes.

The data were analysed using descriptive statistical methods. The findings are presented in a series of one-way frequency tables, facilitating a comprehensive yet accessible representation of the data. Each section is accompanied by interpretations that reflect on possible clinical and epidemiological implications relevant to this geographic and institutional context

The findings of the study are presented as frequency and percentage. Table 1 presents the demographic and smoking pattern of the study group.

1.Demographic and Smoking Profile

The age distribution of the study population (N = 160) revealed that the majority of patients diagnosed with bronchogenic carcinoma were in the age group of 60–69 years, accounting for 35.6% of the sample. This was followed by 27.5% in the 50–59-year age group, and 16.9% between 70–79 years. Patients aged 40–49 years constituted 10%, while the youngest (30–39 years) and oldest (80–89 years) groups comprised 1.9% and 8.1%, respectively.

A pronounced male predominance was observed, with 81.3% of the participants being male and only 18.8% female, indicating a male-to-female ratio of approximately 4.3:1.

In terms of smoking behaviour, a substantial proportion of patients had a smoking index between 500 and 1000 (36.9%). An equal proportion (27.5%) had either a smoking index greater than 1000 or were non-smokers. Only 8.1% had a smoking index below 500.

When evaluating the age of initiation of smoking, 31.3% of individuals reported initiating smoking between 15–20 years of age, while 28.1% had started before the age of 15. A smaller segment (13.1%) began smoking after 20 years, and the remaining 27.5% were non-smokers.

Duration of smoking showed that 58.1% of patients had smoked for more than 30 years, while 14.4% had a smoking history of 20–30 years. As with other smoking-related variables, 27.5% were non-smokers.

These findings underline the predominance of older male smokers with long-term and early-onset smoking habits among patients diagnosed with bronchogenic carcinoma in this cohort.

2. Clinical Presentation

From Table 2 among patients diagnosed with bronchogenic carcinoma, cough emerged as the most common symptom, reported by 76.3% of patients, closely followed by breathlessness (70%) and loss of weight (61.3%). Chest pain was also frequently reported (48.8%), whereas hemoptysis (23.8%), hoarseness of voice (HOV, 16.3%), and fever (5%) were relatively less common.

Physical examination revealed clubbing in a significant majority (91.3%), indicating chronic pulmonary pathology. Lymph node enlargement (LNE) was observed in 36.3% of cases, and pleural effusion in 32.5%. Superior vena cava obstruction (SVCO) was rare, noted in only 3.1% of patients.

The analysis of comorbidities highlighted anaemia as the most common associated condition, seen in 67.5% of the patients. Other prevalent comorbidities included chronic obstructive pulmonary disease (COPD, 53.8%), coronary artery disease (CAD, 43.1%), asthma (30%), past history of pulmonary tuberculosis (PTB, 19.4%), and family history of carcinoma (FHCA, 6.9%).

Performance status, evaluated using the WHO performance status scale, indicated that a large majority (90.6%) of patients presented with poor performance status (score ≥2), emphasizing severe functional impairment at diagnosis. Only a small proportion (9.4%) had a relatively good performance status (score ≤1), highlighting that bronchogenic carcinoma significantly impacted functional capacity in this patient population.

These findings underscore the critical need for early recognition and intervention strategies, considering the severity of clinical symptoms, significant comorbidities, and compromised performance status in patients with bronchogenic carcinoma.

3. Diagnostic evaluation

Among the diagnostic modalities employed to confirm bronchogenic carcinoma in this cohort of 160 patients, sputum cytology proved to be the most commonly utilized and contributory, yielding diagnostic confirmation in 39.4% of cases (Table 3). This was followed by fine-needle aspiration cytology (FNAC) of lymph nodes, which accounted for 23.8% of diagnoses, and lung FNAC, contributing to 19.4%. Pleural fluid (PF) cytology was diagnostic in 10.6% of patients, while fiber-optic bronchoscopy (FOB) was successful in 6.9%, highlighting the varying roles of different modalities based on patient presentation and site accessibility.

Histopathological examination revealed that adenocarcinoma was the most common histological subtype, identified in 43.1% of cases, followed by squamous cell carcinoma in 34.4%. Small cell carcinoma was diagnosed in 9.4%, while non-specific histology was reported in 11.3%, reflecting cases where a conclusive classification could not be made.

These findings underscore the importance of multimodal diagnostic approaches in evaluating suspected bronchogenic carcinoma, with a particular reliance on minimally invasive techniques like sputum cytology and FNAC. The predominance of adenocarcinoma aligns with contemporary trends seen in global and regional lung cancer epidemiology.

4. Disease Characteristics

An evaluation of the staging at presentation (Table 4) revealed that a significant majority of patients were diagnosed at advanced stages of bronchogenic carcinoma. Stage 4 disease was observed in 60.6% of cases, while Stage 3b was present in 21.3%, and Stage 3a in 4.4%. Early-stage detection was uncommon, with Stage 1 and Stage 2 comprising only 0.6% and 3.8%, respectively. Additionally, among patients with small cell lung carcinoma (SCLC), limited-stage disease (SCLS) accounted for 3.1%, whereas extensive-stage disease (SCES) was noted in 6.3%.

Regarding metastatic spread, 50% of patients had no detectable distant metastasis at the time of diagnosis. Among those with metastatic disease, the liver was the most common site (25.6%), followed by the adrenal glands (15.6%) and the brain (6.3%). Combined metastases were less frequent, with 1.2% having both liver and brain involvement, 0.6% with liver and adrenal metastases, and 0.6% with simultaneous involvement of liver, adrenal glands, and brain.

These findings highlight the predominantly late-stage presentation of lung cancer in the studied cohort, emphasizing the need for improved early detection strategies and greater clinical vigilance, particularly in high-risk groups.

Management and Treatment outcome

In this cohort of 160 patients with bronchogenic carcinoma, the majority (89.4%) underwent a combined regimen of chemotherapy and radiotherapy, reflecting the predominant use of non-surgical, multimodal treatment approaches suited for advanced-stage disease. Only 1.9% of patients received surgery combined with chemotherapy, indicating limited operability at the time of diagnosis. Notably, 8.8% of patients received no active treatment, which may reflect either patient-related factors (such as poor performance status) or late-stage presentation precluding intervention.

With respect to survival outcomes, 40.6% of patients survived for 6 to 9 months, while 31.9% had a survival duration of up to 6 months post-diagnosis, highlighting the aggressive nature of the disease and the challenges in prolonging survival. A smaller proportion of patients survived 9 to 12 months (9.4%), and 18.1% achieved a survival duration of 12 months or more.

These findings underscore the poor prognosis typically associated with bronchogenic carcinoma, particularly in settings where diagnosis occurs at an advanced stage. The data also emphasize the reliance on chemoradiation as the primary treatment modality and the urgent need for early detection and personalized therapeutic strategies to improve long-term outcomes.

Summary

This hospital-based cross-sectional study was conducted to assess the clinico-epidemiological characteristics, diagnostic patterns, disease staging, management, and short-term outcomes of patients diagnosed with bronchogenic carcinoma at a tertiary care centre in South India. A total of 160 patients were included over a one-year period, and the findings offer a detailed snapshot of the clinical burden and challenges associated with this malignancy in the regional context.

The demographic profile revealed a clear predominance of older males, with the majority aged between 60 and 69 years, and over 80% of the participants being male. Tobacco exposure was a significant risk factor, with more than 70% of the cohort having a history of smoking. Early initiation and prolonged duration of smoking were commonly reported, reinforcing the etiological link between smoking and lung cancer.

Clinically, most patients presented with non-specific respiratory symptoms such as cough (76.3%), breathlessness (70%), and weight loss (61.3%). Physical findings like clubbing and comorbidities such as anaemia and COPD were prevalent, suggesting chronic disease progression prior to diagnosis. Diagnostic confirmation was primarily achieved through sputum cytology and FNAC techniques. Histologically, adenocarcinoma emerged as the most common subtype, followed by squamous cell carcinoma.

Alarmingly, more than 60% of patients were diagnosed at Stage 4, and over 90% had either Stage 3b or higher, reflecting a significant delay in diagnosis. Metastasis to the liver and adrenal glands was common, with half the patients exhibiting distant spread at presentation.

In terms of management, the vast majority received chemotherapy combined with radiotherapy. Surgical interventions were minimal, reflecting the advanced disease stage. Survival analysis showed that over 70% of patients had a survival duration of less than 9 months, further emphasizing the poor prognosis associated with late-stage bronchogenic carcinoma.

Bronchogenic carcinoma remains a critical public health issue, especially in South India, characterized by its high incidence rates and aggressive clinical features. This study aimed to delineate the demographic, clinical, and pathological characteristics of bronchogenic carcinoma among patients attending a tertiary care center. The findings reflect important trends in the epidemiology and clinical management of this malignancy that resonate with recent data from global and regional studies.

The demographic analysis highlighted that bronchogenic carcinoma predominantly affects older males, with the peak incidence observed in the 60–69-year age group. This trend is consistent with other epidemiological studies which indicate that age is a significant risk factor for bronchogenic carcinoma due to cumulative exposure to carcinogens, particularly from tobacco use (Bray et al., 2018). The substantial male predominance (81.3%) with a male-to-female ratio of 4.3:1 aligns with data from India and other regions with similar tobacco usage patterns (Malhotra et al., 2021).

Smoking behaviour significantly influenced the prevalence of bronchogenic carcinoma in this cohort, with a substantial proportion having a smoking index between 500 and 1000, or even higher. Early initiation of smoking (before age 20) and prolonged smoking duration (>30 years) were notably common, reflecting the strong dose-response relationship between tobacco exposure and lung cancer risk (Doll et al., 2020; Islami et al., 2021).

Clinically, symptoms like cough, breathlessness, and weight loss dominated presentations, mirroring the patterns documented in literature that highlight these as cardinal symptoms indicative of underlying pulmonary malignancies (Lemjabbar-Alaoui et al., 2015). Clubbing, a notable physical finding in 91.3% of patients, is indicative of chronic pulmonary pathology and aligns with its documented association in bronchogenic carcinoma patients (Patel et al., 2019).

Comorbidities, particularly COPD and anaemia, were prevalent. These associations are well-supported by existing studies, which suggest that chronic inflammation and compromised pulmonary function significantly elevate the risk and worsen the prognosis of bronchogenic carcinoma (Vogelmeier et al., 2020; Aapro et al., 2020). The relatively high prevalence of coronary artery disease also corroborates the established links between cardiovascular disease and chronic smoking (Libby et al., 2019).

In this study, sputum cytology emerged as the most frequently employed and effective diagnostic tool, confirming the diagnosis in 39.4% of cases. Fine-needle aspiration cytology (FNAC) of lymph nodes was the second most common method, accounting for 23.8% of diagnoses, followed by lung FNAC, which contributed to 19.4%. These findings underscore the value of sputum cytology and FNAC as primary diagnostic approaches, particularly in resource-constrained settings and among patients for whom invasive techniques may not be suitable (Lee et al., 2022). Regarding histological subtypes, adenocarcinoma was the most prevalent, detected in 43.1% of patients, with squamous cell carcinoma comprising 34.4%, and small cell carcinoma 9.4%. These results are consistent with an Indian study by Choudhary CR et al. (2020), where squamous cell carcinoma was most common (43.52%), followed by adenocarcinoma (38.89%), small cell carcinoma (13.89%), and large cell carcinoma (3.70%).

The histopathological predominance of adenocarcinoma aligns with global trends showing a shift from squamous cell carcinoma to adenocarcinoma, possibly due to changes in tobacco usage patterns and increased environmental carcinogen exposure (Travis et al., 2021).

Disease staging demonstrated a substantial majority of patients presenting with advanced disease (Stage 4 and 3b), reflective of late clinical presentations and diagnostic delays. This finding is consistent with other Indian studies which underline late-stage diagnosis as a significant barrier to effective management and improved survival (Aggarwal et al., 2022). The high incidence of distant metastasis, particularly liver and adrenal involvement, is typical of advanced-stage bronchogenic carcinoma, necessitating aggressive and multimodal therapeutic strategies (Goldstraw et al., 2016).

Treatment outcomes underscored a predominant reliance on chemoradiation therapy, with surgery rarely employed, indicative of advanced disease at diagnosis limiting surgical interventions (Mok et al., 2019). Survival analysis further emphasizes the aggressive nature of bronchogenic carcinoma, as survival beyond 12 months was achieved only in a minority (18.1%), highlighting the need for early detection, targeted therapies, and robust supportive care frameworks to enhance patient survival and quality of life (Hirsch et al., 2017).

In summary, this study uncovers a concerning trend of late diagnoses, advanced-stage presentations, and poor survival rates among patients with bronchogenic carcinoma. It underscores the urgent necessity for enhanced public health strategies focused on smoking cessation, early screening initiatives, and increased community awareness about the risks linked to bronchogenic carcinoma. Employing comprehensive methods aimed at early detection and timely intervention could substantially improve the prognosis for lung cancer patients in this area. Strengthening awareness and referral processes within primary care settings may be crucial in enhancing survival outcomes for this population. Furthermore, ongoing research should focus on innovative diagnostic and treatment options to address the changing landscape of lung cancer epidemiology in South India.

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