Evolving Trends in Surgically Managed Lung Cancer: A 16-Year Hospital-Based Epidemiological Analysis

Purpose

To investigate longitudinal trends in clinical-epidemiological characteristics among surgically treated lung cancer patients and assess implications for prevention strategies.

Methods

A retrospective analysis was conducted on patients diagnosed with lung cancer and surgically treated at Fudan University Shanghai Cancer Center (2006–2021). Socio-demographics, clinical and pathological data were collected. Continuous and categorical data variables were analyzed using non-parametric tests and chi-square tests, respectively, with trend analysis conducted by linear regression.

Results

A total of 21,743 patients with a median age of 59 were included of whom 11,802 (54.3 %) were women. From 2006 to 2021, the female proportion surged from 29.9 % to 59.5 %, paralleled by an increase in patients aged < 45 years (6.2 % to 15.4 %), with young females rising from 3.4 % to 19.2 %. Non-smokers predominated (72.0 % in 2021 vs. 42.3 % in 2006), particularly among women (97.5 % non-smokers), and the overall proportion of female non-smokers increased from 26.8 % to 58.5 %. Adenocarcinoma prevalence increased from 51.7 % to 82.9 % in females, while squamous carcinoma declined from 31.0 % to 4.1 %. Early-stage diagnoses (Stage 0-I) increased from 37.1 % to 85.0 %, coinciding with health checkup-driven detection rising from 44.0 % to 70.5 %. The EGFR mutation rate in adenocarcinoma was notably high in females (69.4 %) and non-smokers (68.9 %).

Conclusions

The rising percentage of non-smokers, growing incidence of lung cancer among young females, increase in early-stage lung cancer cases, and shift in major pathological subtypes present potential challenges and directions for lung cancer prevention and control in China. The emergence of lung cancer in young non-smoking females and its underlying factors warrant further research.