An International Registry Study of Early-Stage NSCLC treatment variations (LUCAEUROPE) in Europe and the USA highlighting variations.

Objective: Harmonized European NSCLC incidence, treatment approach, and survival based on national tumor registries are unclear.
Summary Background Data: Surgery has the potential to cure NSCLC and significantly prolong survival. This large-scale international study aimed to investigate treatment variations in Europe and the USA, as well as the determinants for its utilization.
Methods: The retrospective cohort study analyzed data from six European national population-based cancer registries (Belgium, Denmark, Estonia, Germany, the Netherlands, and Slovenia) and the US SEER database from 2010-2015.
Results: The study computed cancer incidence, survival, and age-standardized proportions of the use of various therapies. Multivariable logistic regression models were used to assess associations between resection and demographic and clinical parameters. A total of 428,107 records were analyzed. Among all countries, Estonia had the highest surgical resection rate (79.3 %) and the lowest radiation rate (7.3 %) for stage I patients. The Netherlands had the highest rate of radiotherapy across all years of investigation and the lowest surgery rate between 2012 and 2015. The primary treatment for early-stage NSCLC showed significant international variation, with the USA having a decrease in surgical rates from 67.6 % to 59.5 %. Resection was less frequently performed as tumor stage increased, patients aged, other lung cancer besides adenocarcinoma was present, and when the tumor site overlapped multiple lobes.
Conclusions: Resection rates have declined in some studied European countries and the USA and resection rates vary substantially among countries. Interpretation of current scientific lung cancer evidence and international guidelines results in wide variations in patient treatment.
Competing Interests: Declaration of Competing Interest A.F.T.M. Verhagen reports institutional payments from Johnson & Johnson and Bristol Myers Squibb. Kersti Oselin declares research grants from Pfizer to study the role of artificial intelligence and genomic factors in lung cancer recurrence 2021 and an ongoing research collaboration with Optellum to develop an artificial intelligence tool to assess lung cancer prognosis. She reports travel support from MSD, Roche and Astra Zeneca. H. Winter reports consultancy fees, travel support and data safety monitoring honoraria from Astra Zeneca, Roche and Intuitive Surgical. All other authors declare no competing interests.
(Copyright © 2024. Published by Elsevier Ltd.)