e20118 Background: Major advances in lung cancer detection and staging have occurred over the past two decades, including widespread adoption of endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA), navigational bronchoscopy, and low-dose CT (LDCT) screening. The population-level impact of these advances on stage at diagnosis and completeness of pretreatment staging remains uncertain. We evaluated national trends in lung cancer stage distribution to characterize changes in diagnostic patterns and staging over time. Methods: We conducted a population-based analysis of Surveillance, Epidemiology, and End Results (SEER) data from 2004–2022, calculating age-adjusted lung cancer incidence stratified by stage at diagnosis (localized, regional, distant, unstaged). Temporal changes in stage-specific incidence rates and proportions were compared between 2004–2006 and 2020–2022. Five-year relative survival was assessed for cases diagnosed between 2000 and 2022. Results: Marked shifts in stage distribution were observed over the study period. Age-adjusted incidence of localized-stage lung cancer increased from 10.8 to 13.4 per 100,000 (+24%; p < 0.001), while distant-stage incidence declined from 33.1 to 20.4 per 100,000 (−38%; p < 0.001). The incidence of unstaged disease decreased by 60%, from 6.8 to 2.7 per 100,000 ( p < 0.001). Correspondingly, the proportion of patients diagnosed with localized disease increased from 17.0% in 2004–2006 to 28.2% in 2020–2022, whereas the proportion diagnosed with distant-stage disease declined from 50.9% to 45.8%. Over the same period, five-year relative survival improved from 15.1% among cases diagnosed in 2000 to 27.9% among those diagnosed in 2017, representing an 85% relative increase. Conclusions: Between 2004 and 2022, lung cancer staging in the United States improved markedly, with a substantial decline in unstaged disease and a shift toward earlier-stage diagnosis, reflecting more complete pretreatment evaluation. These changes coincided with the widespread adoption of modern staging technologies and low-dose CT screening. Prospective, patient-level studies linking specific diagnostic modalities to staging completeness, treatment selection, and outcomes will be required to confirm causality. Stage distribution at diagnosis: Before and after comparision. Stage 2004-2006Early Period 2020-2022Recent Period Localized 16.7% 29.5% Regional 22.5% 19.3% Distant 51.2% 44.9% Unstaged 9.6% 6.3%
Das et al. (Thu,) studied this question.