https://doi.org/10.4081/monaldi.2026.4380
Treatment patterns and survival trends among patients with advanced-stage non-small cell lung cancer in Pakistan: a cancer registry-based flexible parametric analysis
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Accepted: 13 October 2026
Published: 22 October 2026
This study aimed to describe trends in survival by treatment modality in advanced-stage (III-IV) non-small cell lung cancer (NSCLC) patients. A retrospective observational study was conducted. Patients diagnosed with primary NSCLC stage III-IV were included from the Cancer Registry of the Aga Khan University Hospital, Karachi, Pakistan. A flexible parametric (Royston-Parmar) model was used to estimate survival trends by treatment modality, sex, and age group. Overall, 663 patients were included; 489 (73.76%) were males. Eighty-one (12.22%) received ‘radiotherapy only’, 217 (32.73%) ‘systemic therapy only’, 136 (20.51%) ‘systemic therapy with radiotherapy’, 34 (5.13%) underwent ‘surgery ± additional treatment’, and 195 (29.41%) did not receive any treatment. Overall, predicted survival increased across all treatment modalities from 2011 to 2019, including the ‘no treatment’ group. In stage III disease, the absolute change in 1- and 2-year survival was most pronounced in the ‘radiotherapy only’ group, at 25.71% and 20.62%, respectively. In stage IV disease, the absolute change in 1-year survival was largest in the ‘no treatment’ group (24.44%) and in 2-year survival in the ‘surgery ± additional treatment’ group (33.46%). For ‘surgery ± additional treatment’ in stage III disease, patients aged >60 years had significantly lower odds of receiving surgery [odds ratio (OR) 0.25, 95% confidence interval (CI) 0.09-0.70, p=0.008]. Among stage IV patients, those diagnosed in 2017-2019 had significantly lower odds of receiving ‘radiotherapy only’ (OR 0.46, 95% CI 0.23-0.92, p=0.027), while squamous cell carcinoma histology was associated with significantly higher odds of receiving ‘radiotherapy only’ (OR 2.23, 95% CI 1.06-4.71, p=0.036). In conclusion, survival improved across all treatment modalities, including among untreated patients. Survival differences across modalities, including with surgical resection and combined therapy, most likely reflect selection of patients with more favorable prognostic profiles. Therefore, these findings should be interpreted as real-world treatment patterns and associated survival trends rather than evidence of comparative treatment efficacy.
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