Clinicopathological and molecular profile of lung cancer: real world data from Georgia

Background: Lung cancer (LC) is a leading cause of cancer-related death in Georgia, yet clinicopathological data remain limited. This study evaluates the characteristics and trends of newly diagnosed LC patients at the country’s largest tertiary referral center. Materials and Methods: Between 2023 and 2025, 270 patients with LC were assessed at an academic hospital in Tbilisi. Demographic, clinical, radiological, pathological, and molecular data were analyzed. Results: The median age was 67 years; 86% of the patients were male (male-to-female ratio: 6.1:1). Most patients (88%) were current or former smokers; 46% were heavy smokers. Cough and dyspnea were the most commonly presenting symptoms. Bronchoscopy was used for diagnosis in 51% of patients, while PET-CT was performed in only 18% due to limited access. Non-small cell lung cancer (NSCLC) accounted for 83% of cases (52% adenocarcinoma, 38% squamous cell carcinoma). Small cell lung cancer (SCLC) comprised 17%. Among those tested, 15.6% were EGFR-positive, 10% were ALK-positive, and 28% had high PD-L1 expression (TPS > 50%). Advanced disease (stage IV or extensive stage) was seen in 67% of the patients, with bone and contralateral lung being the most frequent metastatic sites. Only 5% had stage I–II disease. Family history of cancer was noted in 17% of patients, including 6% with a family history of LC. Adenocarcinoma was more frequent in nonsmokers (p = 0.009). No association was found between PD-L1 status and smoking. Conclusions: Most LC cases are diagnosed at an advanced stage. Targetable mutations are common, highlighting the importance of routine biomarker testing. Preventive strategies and early detection are critical to improving outcomes.