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. 2025 May 29;25(1):966.
doi: 10.1186/s12885-025-14334-2.

Epidemiology, patient management, and survival outcomes in resected patients with non-metastatic non-small cell lung cancer: a nationwide real-world study

Stéphane Renaud  1 , Paul Casabianca  2 , Pauline Diez-Andreu  3 , Mélanie Chartier  2 , Anne-Françoise Gaudin  2 , Françoise Bugnard  3 , Stève Bénard  3 , François-Emery Cotté  2 , Christos Chouaid  4
Affiliations

Epidemiology, patient management, and survival outcomes in resected patients with non-metastatic non-small cell lung cancer: a nationwide real-world study

Stéphane Renaud et al. BMC Cancer. .

Abstract

Introduction: Surgery is the standard of care for eligible patients with localized or stage IIIA locally advanced non-small cell lung cancer (NSCLC) current guidelines recommend the most conservative surgeries possible. The aim of this study was to bring new real-world data on resected NSCLC epidemiology, management, and survival outcomes in patients with resected non-metastatic NSCLC.

Materials and methods: This is a descriptive, non-interventional, national, retrospective claims study using data from the French National Hospitalization Database (PMSI) describing the management of patients with non-metastatic NSCLC who underwent a first lung resection (LR) between 2015 and 2019. Patients with LR performed in 2015 were followed from LR until the last registered hospital care or in-hospital death. Five-year disease-free survival (DFS [i.e., time from LR to first recurrence or death]) and overall survival (OS) were assessed.

Results: The rate of patients with non-metastatic NSCLC and a first LR between 2015 and 2019 increased by an average of 4.5% per year (8,688 in 2015 vs. 10,330 in 2019). Lobectomy (79.8% vs. 84.9%) and video-assisted thoracoscopic surgery (29.6% vs. 46.4%) became more frequent. Five-year DFS was 33.7% [95%CI 29.8-37.6%] following infralobar resection, 52.3% [51.0-53.5%] after lobectomy, 42.3% [36.9-47.5%] after bilobectomy, and 33.6% [30.0-37.2%] after pneumonectomy. Respective five-year OS from LR were 58.4% [54.1-62.4], 70.2% [69.0-71.3], 59.3% [53.7-64.4], and 46.3% [42.3-50.2].

Conclusions: This study highlights the increasing trend toward conservative and less invasive surgeries in resected NSCLC. Type of LR can be used as an indirect marker of disease expansion, with poorer survival outcomes in case of extensive surgeries.

Keywords: (MeSH): non-small cell lung cancer; Epidemiology; Insurance claim review; Pulmonary surgical procedures; Survival outcomes.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study has been conducted in accordance with International Society for Pharmacoepidemiology guidelines for Good Pharmacoepidemiology Practices and applicable regulatory requirements, including the French Data Protection Agency (Commission Nationale de l’Informatique et des Libertés– CNIL) opinion n°2018 − 257 of June 7, 2018 on regulatory requirements and governance for processing PMSI data under expedited regulatory process (MR-006– see https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000037187571). This study was carried out in compliance with the principles set in the Helsinki Declaration. As per MR-006 process, this study only uses secondary data from claims database, qualifying as research not involving human subjects and thus no informed consent or review by an ethics committee is required. Studies carried out using PMSI data must be audited to ensure their compliance with authorized purposes. Also, a collective information note has been added to both stève consultants and BMS websites for this purpose. This information specifies that data subjects have rights of access, rectification and opposition on their data, which may be exercised by contacting the director of the organization managing the compulsory health insurance scheme to which they belong. Consent for publication: Not applicable– as per MR-006 process. Competing interests: SR reports receiving fees from Medtronic, Intuitive Surgical, Astra-Zeneca, BMS and BD/BARD for consulting activities. CC reports receiving honoraria from AstraZeneca, Boehringer Ingelheim, Clovis, GlaxoSmithKline, Hoffman-La Roche, Lilly, Pfizer, BMS, MSD, Novartis, Accord Healthcare, Sandoz, Janssen, Takeda, Sanofi, Pierre Fabre and Amgen for congress participation, communications, training and research work. PDI, FB and SB are employees of stève consultants– a Cytel company– that has been contracted to conduct this study. PC, MC, AFG and FEC are employees of Bristol Myers Squibb.

Figures

Fig. 1
Fig. 1
Patient disposition– study population
Fig. 2
Fig. 2
Type of lung resection according to NSCLC therapy in 2015 incident, resected, non-metastatic NSCLC
Fig. 3
Fig. 3
Disease-free survival (DFS) and overall survival (OS) from lung resection by Kaplan-Meier method. A– Time to first recurrence or in-hospital death (DFS) from lung resection in 2015 incident, resected, non-metastatic NSCLC patients. B– Time to in-hospital death (OS) from lung resection in 2015 incident, resected, non-metastatic NSCLC patients. C– Time to first recurrence or in-hospital death (DFS) from lung resection in 2015 incident, resected, non-metastatic NSCLC patients according to type of lung resection. D– Time to in-hospital death (OS) from lung resection in 2015 incident, resected, non-metastatic NSCLC patients according to type of lung resection
Fig. 4
Fig. 4
Overall survival (OS) from local or distant recurrence by Kaplan-Meier method. A– Time to in-hospital death (OS) from local recurrence in 2015 incident, resected, non-metastatic NSCLC patients. B– Time to in-hospital death (OS) from distant recurrence in 2015 incident, resected, non-metastatic NSCLC patients
Fig. 5
Fig. 5
Costs associated with healthcare resource utilization at index stay [lung resection] according to type of surgery (A) and monthly costs during follow-up [period after lung resection] according to recurrence status (B)
See this image and copyright information in PMC

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