Primary lung cancer in Palestine: advanced presentation, sex-specific smoking patterns, and systemic inflammatory burden in a hospital-based cohort

Background Lung cancer remains a major cause of cancer mortality, yet detailed hospital-based clinicopathologic data from Palestine are limited. We characterized demographic, smoking, histologic, staging, symptom, and inflammatory features of patients with primary lung cancer and evaluated the robustness of key findings to diagnostic uncertainty and missing data. Methods We conducted a retrospective, single-center, hospital-based observational study et al.-Makassed Islamic Charitable Society Hospital in East Jerusalem, a tertiary referral and teaching hospital serving patients referred from Jerusalem, the West Bank, and the Gaza Strip. The deidentified source dataset represented first qualifying hospital encounters from 23 February 2015 through 23 March 2026; some historical diagnoses preceded the index encounter. After patient-level deduplication and clinical validation, 175 patients with pathologically confirmed primary lung cancer or, when tissue confirmation was not feasible, a definitive clinician-documented clinical/radiologic diagnosis were included. Analyses used variable-specific available-case denominators; no imputation was performed. Sensitivity analyses examined pathologically confirmed cases and the influence of unknown/unspecified histology. Results Among 175 patients, mean age was 61.7 ± 11.8 years and 146 (83.4%; 95% CI 77.2–88.2%) were male. Current or former smoking was documented in 111 (63.4%; 95% CI 56.1–70.2%) of the total cohort, although smoking status was unknown in 39 (22.3%). Among 131 patients with known stage/metastatic status, 85 (64.9%; 95% CI 56.4–72.5%) had stage IV disease and 93 (71.0%; 95% CI 62.7–78.1%) had metastatic disease at presentation. Among pathologically confirmed patients with known metastatic status, 78/109 (71.6%) were metastatic, supporting the descriptive robustness of late presentation. Symptom burden showed a weak positive correlation with C-reactive protein (Pearson r = 0.25, 95% CI 0.00–0.47; n = 64; p = 0.044). Conclusion In this hospital-based Palestinian cohort, advanced and metastatic presentation was common among evaluable patients. The findings support strengthening tobacco control, diagnostic pathways, and pathology capacity, but they do not establish population incidence, causal health-system effects, or the immediate feasibility of a national screening program. Prospective multicenter and registry-linked studies are needed.