# Real-world treatment patterns and outcomes for patients with non-metastatic non-small cell lung cancer: retrospective analyses in Canada, England, and Germany

## TL;DR

This study compares real-world treatment and survival outcomes for non-metastatic non-small cell lung cancer patients in Canada, England, and Germany.

## Contribution

It provides a baseline for treatment patterns and survival outcomes before widespread use of modern therapies like immunotherapy.

## Key findings

- Treatment rates decreased with higher cancer stages, with stage III patients receiving less surgery and more systemic therapy.
- Median survival was longest for stage I/II patients who had surgery and shortest for stage IIIB/IIIC patients treated with systemic therapy alone.
- The data will serve as a reference for evaluating future treatment advancements in non-metastatic NSCLC.

## Abstract

Recent therapeutic advancements for non-metastatic non-small cell lung cancer (NSCLC) have increased the need for real-world baselines against which future changes in patient management and clinical outcomes can be compared.

Data on patient characteristics, initial treatment, and overall survival (OS) were derived from adult patients diagnosed with stage I-IIIC NSCLC (2010–2020) in a regional Canadian database (Oncology Outcomes [O2]), an English national registry (Cancer Analysis System [CAS]), and four regional German registries (VONKOdb) and retrospectively analyzed separately using analogous methodology.

Data from 85,433 patients were analyzed. Stage at diagnosis varied, with proportions with stage I NSCLC ranging from 30.9% (VONKOdb) to 44.2% (O2) and with stage III disease from 36.9% (O2) to 48.5% (VONKOdb). Across the data sources, proportions receiving surgery ± other treatments were similar for stages I and II, but decreased through stages IIIA, IIIB, and IIIC (range, 24.7–42.7%, 4.6–21.8%, and 0.9–7.5%, respectively). Overall, 70.3–85.2% of patients received active treatment for NSCLC, with a trend toward lower proportions among those with stage III disease. Reached median OS tended to be longest in patients with resected stage I/II NSCLC (range, 28.8–128.0 months) and shortest in patients with stage IIIB/IIIC disease treated with systemic anticancer therapy (SACT) alone, radiotherapy alone, or SACT + palliative radiotherapy (range, 4.8–21.2 months).

These data provide insights into treatment pathways and survival outcomes before the widespread use of immunotherapy-based and targeted therapies and will serve as an important baseline for future evaluations of emerging treatments for patients with non-metastatic NSCLC.

The online version contains supplementary material available at 10.1186/s12890-025-03715-9.