Real-world trends in diagnosis, treatment, and survival of non–small cell lung cancer in Vietnam

BACKGROUND: Evidence describing temporal changes in disease stage, molecular testing, treatment patterns, and survival outcomes in non-small cell lung cancer (NSCLC) from low- and middle-income countries remains scarce. We assessed longitudinal real-world trends in NSCLC management and outcomes at a provincial oncology center in Vietnam over more than six years. METHODS: This retrospective observational study included consecutive adults with histologically confirmed NSCLC treated at Nghe An Oncology Hospital, Vietnam between January 2018 and August 2024 (n = 3,087). Trends in stage at diagnosis (AJCC 8th edition), biomarker testing uptake (primarily epidermal growth factor receptor [EGFR]; limited anaplastic lymphoma kinase [ALK]), and first-line treatment modalities were evaluated. Overall survival (OS) was estimated using the Kaplan-Meier method and compared across diagnosis periods using log-rank tests. Multivariable Cox proportional hazards models were used to identify independent prognostic factors. RESULTS: The median age was 64 years (range, 24-97), 73.5% were male, 71.6% had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, and adenocarcinoma accounted for 77.0% of cases. The proportion of early-stage disease (stage I-II) increased from 3.1% in 2018 to 9.8% in 2023-2024, while stage III disease declined from 33.3% to 20.4%. Molecular testing uptake increased from 28.7% to a peak of 65.1% in 2022 and remained approximately 60% thereafter. Use of first-line targeted therapy rose from 7.7% to 20.8%, and immunotherapy from 0% to 2.5%. Median OS improved from 12.0 months in 2018 to 21.7 months in 2023-2024 (log-rank p < 0.001). Diagnosis during 2021-2024 was independently associated with lower mortality compared with 2018-2020 (adjusted HR 0.80, 95% CI 0.73-0.87). CONCLUSIONS: Substantial improvements in diagnosis, molecular testing, and treatment adoption were observed over time and were associated with significantly improved survival in a large real-world Vietnamese NSCLC cohort.