A 24-Year Pathological Pattern and Survival Analysis of Lung  Cancer Patients: A Single-Center Study in Northern Iran  (2001–2024)

Danial Fazilat-panah; Seyed Reza Najafi; Hoda Shirafkan; Fahime Khoshparast; Shabnam Ashofte; Sogand Beheshti; Ghazaleh Tahernezhad

doi:10.31557/apjcc.2026.11.3.407-418

Authors

Danial Fazilat-panah Assistant Professor of Radiation Oncology, Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0000-0003-4194-6575
Seyed Reza Najafi Bachelor’s Degree in Radiotherapy, Student Research and Technology Committee, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0009-0000-0287-7023
Hoda Shirafkan Associate Professor of Biostatistics, Traditional Medicine and History of Medical Sciences Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0000-0002-5682-1153
Fahime Khoshparast Bachelor’s Degree in Radiotherapy, Student Research and Technology Committee, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0009-0008-2604-7022
Shabnam Ashofte Residency of Radiation Oncology, Cancer Research Center, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0009-0009-8311-4006
Sogand Beheshti Bachelor’s Degree in Radiotherapy, Student Research and Technology Committee, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0009-0008-4778-4494
Ghazaleh Tahernezhad Student Research and Technology Committee, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0009-0005-7406-436X

DOI:

https://doi.org/10.31557/apjcc.2026.11.3.407-418

Keywords:

Lung Cancer, Non-Small Cell Lung Cancer, Small Cell Lung Cancer, Brain metastasis, Overall Survival, Histopathological patter.

Abstract

Introduction: Lung cancer remains the leading cause of cancer-related mortality worldwide, with limited survival in low- and middle-income countries due to late diagnosis and restricted access to advanced therapies. Longterm cohort data from underrepresented regions such as northern Iran are scarce. This study seeks to provide insights into disease progression in the region and contribute to future strategies for improved diagnosis, treatment, and prevention.

Materials and Methods: This 24-year retrospective cohort included 957 patients with primary lung cancer treated at Shahid Rajaee Radiotherapy Center in northern Iran. Demographic, histopathological, and survival data were analyzed using Kaplan–Meier estimates and log-rank tests, and prognostic factors were assessed with Cox proportional hazards models. A scenario-based sensitivity analysis was performed to examine the impact of missing mortality data.

Results: The mean age at diagnosis was 62.5±11.6 years. NSCLC constituted the majority of cases, predominantly squamous cell carcinoma and adenocarcinoma. Median overall survival (OS) was significantly longer in NSCLC than SCLC (29 vs. 13 months, p<0.01). Overall survival was 39.9%, with 1-, 2-, and 5-year survival rates of 60.8%, 48.5%, and 41.4%, respectively. Metastatic status particularly brain metastasis was the strongest predictor of mortality (HR=1.767, 95% CI: 1.464–2.132, p<0.001). Sensitivity analysis demonstrated that OS declined to 8% under the most conservative assumption that all patients with unknown status were deceased, indicating potential overestimation of survival due to missing follow-up data.

Conclusion: This long-term cohort underscores the prognostic significance of metastatic burden especially brain involvement and reveals survival patterns shaped by referral-center dynamics and incomplete follow-up. These findings highlight the need for improved early detection, molecular profiling, and broader access to contemporary systemic therapies to enhance lung cancer outcomes in resource-limited settings.