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

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. 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. 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). 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.