Temporal Trends And Epidemiologic Shifts In Non-Small Cell Lung Cancer Incidence And Outcomes

Abstract

Non-small cell lung cancer (NSCLC) is the most prevalent subtype of lung cancer worldwide and has undergone substantial epidemiologic transformation over the past two decades. Changes in histologic distribution, stage at diagnosis, and survival outcomes reflect evolving environmental exposures, diagnostic strategies, and therapeutic innovations. This study aimed to examine 20-year temporal trends in NSCLC incidence, mortality, histologic patterns, and survival outcomes. A secondary objective was to evaluate the diagnostic utility of liquid biopsy as a non-invasive alternative to conventional tissue biopsy. A retrospective cohort study was conducted using population-based data from the Surveillance, Epidemiology, and End Results (SEER) 18 Registries (2000–2020) and the Global Cancer Observatory (GLOBOCAN) 2020. Joinpoint regression, Kaplan-Meier survival analysis, and multivariable Cox proportional hazards models were applied to assess incidence, mortality, and survival trends. Liquid biopsy was descriptively compared with tissue biopsy using current clinical performance data. Statistical significance was assessed at a two-tailed p-value of <0.05. NSCLC incidence and mortality declined by 14.8% and 27.4%, respectively. Early-stage diagnoses and the prevalence of adenocarcinoma increased substantially. Five-year survival improved across all subgroups. Liquid biopsy demonstrated clinical utility and feasibility in advanced-stage disease but showed reduced sensitivity in early-stage detection. The findings underscore substantial epidemiologic progress and support the integration of liquid biopsy to enhance equitable, non-invasive diagnostics in NSCLC.