Incidence and survival of Lung Cancer: A retrospective population-based cohort (Monastir, Tunisia: 2002–2022)

Abstract

INTRODUCTION: Lung cancer (LC) remains one of the most lethal malignancies worldwide. In Tunisia, LC population-level data is limited. This study aimed to estimate the incidence, mortality, trends burden and survival outcomes of LC over two decades in Monastir (Tunisia). METHODS: We conducted a retrospective population-based cohort including all LC patients diagnosed between 2002 and 2014 in the governorate of Monastir, with follow-up until 2022. Age-standardized incidence and mortality rates (ASIR and ASMR) were calculated and expressed per 100,000 Person-Years (PY). Trends were analyzed using Joinpoint regression to determine Annual Percent Change (APC). Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLL), and Years Lived with Disability (YLD) were computed. Survival analysis was performed using Kaplan-Meier estimates, and multivariable Cox proportional hazards regression was used. RESULTS: LC ASIR per 100,000 PY was 18.37 (95% CI: 15.1-21.7), 33.63 (29.3-38.0) in males, and 4.50 (2.75-6.41) in females. ASMR per 100,000 PY was 12.33 (9.2-15.84), 24.84 (19.9-29.82) in males, and 2.0 (0.6-3.42) in females. Incidence showed a significant upward trend (APC 8.23%, 95% CI: 2.66-16.12), particularly in females (APC 17.99%, 95% CI: 9.86; 33.27). Projected ASIRs were 43.7 per 100,000 PY in 2025 (95% CI: 37.1-50.3) and 64.7 per 100,000 PY in 2030 (95% CI: 56.7-72.7). DALYs attributable to LC were 1,328 per 100,000 PY, comprising 1,198.8 YLLs and 129.2 YLDs. One-year and five-year survival rates were 43.2% (95% CI: 36.6-49.8) and 22.1% (95% CI: 17.4-26.8), respectively, with a median survival of 10 months (95% CI: 8.9-11.0). Survival was higher among females, younger patients (<65 years), and those diagnosed after 2009, with an improved median survival. CONCLUSION: LC incidence and mortality are rising, with low survival and a substantial burden of premature mortality, highlighting the urgent need for population-based prevention programs.