The approval of immunotherapy (I-O) for the treatment of late-stage non-small cell
lung cancer (NSCLC) opened new perspectives in improving survival outcomes. However,
survival data have not yet been provided from the period of the Covid-19 pandemic.
The aims of our study were to assess and compare survival outcomes of patients with
advanced LC receiving systemic anticancer treatment (SACT) before and after the approval
of immunotherapy in Hungary, and to examine the impact of pandemic on survival outcomes
using data from the Hungarian National Health Insurance Fund (NHIF) database.This
retrospective, longitudinal study included patients aged ≥20 years who were diagnosed
with advanced stage lung cancer (LC) (ICD-10 C34) between 1 January 2011 and 31 December
2021 and received SACT treatment without LC-related surgery. Survival rates were evaluated
by year of diagnosis, sex, age, and LC histology.In total, 35,416 patients were newly
diagnosed with advanced LC and received SACT during the study period (mean age at
diagnosis: 62.1-66.3 years). In patients with non-squamous cell carcinoma, 3-year
survival was significantly higher among those diagnosed in 2019 vs. 2011-2012 (28.7%
[95% CI: 26.4%-30.9%] vs. 14.45% [95% CI: 13.21%-15.69%], respectively). In patients
with squamous cell carcinoma, 3-year survival rates were 22.3% (95% CI: 19.4%-25.2%)
and 13.37% (95% CI: 11.8%-15.0%) in 2019 and 2011-2012, respectively, the change was
statistically significant. Compared to 2011-2012, the hazard ratio of survival change
for non-squamous cell carcinoma patients was 0.91, 0.82, and 0.62 in 2015-2016, 2017-2018,
and 2019, respectively (p<0.001 for all cases). In the squamous cell carcinoma group,
corresponding hazard ratios were 0.93, 0.87, and 0.78, respectively (p<0.001 for all
cases). Survival improvements remained significant in both patient populations during
the Covid-19 pandemic (2020-2021). No significant improvements were found in the survival
of patients with small cell carcinoma. Platinum-based chemotherapy was the most common
first-line treatment in all diagnostic periods, however, the proportion of patients
receiving first- or second-line immunotherapy significantly increased during the study
period.3-year survival rates of NSCLC almost doubled among patients with non-squamous
cell carcinoma and significantly improved at squamous cell carcinoma over the past
decade in Hungary. Improvements could potentially be attributable by the introduction
of immunotherapy and were not offset by the Covid-19 pandemic.
