A comprehensive analysis of lung cancer status changes over 10 years: results of Moroccan cohort

BACKGROUND: Assessing long-term trends in lung cancer (LC) patients is challenging, particularly in regions with limited data. We present findings from a real-life Moroccan cohort. METHODS: This is a retrospective study that included patients diagnosed with LC as a primary malignancy between January 1st, 2013, and December 31st, 2022. Data were collected from one academic public hospital that, during this period, served as the referral centre for the middle and southern regions of Morocco. Patients', clinic, pathologic, and therapeutic characteristics were described. Analyses assessed temporal trends and stage-specific outcomes. RESULTS: Over the study period, LC rates were highest among men 88% (1206/1369), aged 55-60 years 22% (297/1369), who were current smokers 90% (1075/1206), while rates among women remained stable. Additionally, a rising trend was observed among NSCLC, particularly adenocarcinoma (56% (34/61) in 2013 vs. 65% (80/124) in 2022; p < 0.001), at the metastatic stage 72% (949/1320), whereas small-cell lung cancer (SCLC) remained under-represented at 4.4% (59/1337) in the overall population and 40% (59/146) in the lung neuroendocrine tumour (LNET) population, with stable incidence at 3% (2/70) in 2013 vs. 6% (10/163) in 2018 vs. 1.6% (3/190) in 2022; p = 0.8. Molecular testing was limited to EGFR in 6% of cases, ALK in 4.4%, and PD‑L1 in 5%. Systemic treatment was dominated by chemotherapy ±platinum, and only 7 patients received second‑line erlotinib. No improvement in survival rates was observed, and early mortality remained high 3-month rate: 0% for localised, 13.2% (95% CI, 9.9-17.2) for locally advanced, and 22.2% (95% CI, 19.6-25) for metastatic stage. CONCLUSION: This is the only, largest, retrospective, real-life cohort study including LC patients in the African region. The trend showed an overall rising LC incidence, a consistent predominance of advanced-stage diagnoses, high mortality rates, and a lack of survival improvement with limited therapeutic options over the studied decade. Strengthening efforts in early detection, tobacco-control, and expanding diagnostic capacity, while ensuring equitable access to biomarker testing and targeted treatments, remains central.